Ver el código de «Oncologic therapy related adverse events»

==Background==
Many of the oncologic therapies currently employed involved immune system checkpoint inhibition which allow for improvement of T-cell activation towards cancer cells. This boost to the immune system can occur by many mechanisms that encompass the list of "novel" oncologic agents" described below.<ref>Shah, M., Rajha, E., DiNardo, C., Muckey, E., Wierda, W. G., & Yeung, S. C. J. (2020). Adverse Events of Novel Therapies for Hematologic Malignancies: What Emergency Physicians Should Know. Annals of Emergency Medicine, 75(2), 264–286. https://doi.org/10.1016/j.annemergmed.2019.07.015</ref>

==Clinical Features==
*Many novel oncologic therapies and [[Biologic immunomodulators]] adverse reactions may mimic common ED presentations such as sepsis.
===Types of novel oncologic agents===
*Genetically engineered T cells
**CD19–chimeric antigen receptor (CAR)-T cell therapy
*[[Biologic immunomodulators|Monoclonal Antibodies]] against PD-1 checkpoints
*Small-molecule inhibitors
*Monoclonal antibodies against cell surface antigens
*Antibody-drug conjugates
*Immunotoxins
*Bispecific T-cell engagers

==Differential Diagnosis==
{{oncologic therapy adverse events}}


==CAR-T cells medications==
===Tisagenlecleucel (Kymriah)===
*Indications: 
**Acute lymphoblastic leukemia
**Large B-cell lymphoma
*Adverse events include:
**[[Cytokine release syndrome]]
**[[Hypogammaglobulinemia]]
**[[Pancytopenia]]
**[[Altered mental status]]
===Axicabtagene ciloleucel (Yescarta)===
*Indications: 
**Acute lymphoblastic leukemia
**Large B-cell lymphoma
*Adverse events include:
**[[Cytokine release syndrome]]
**[[Pancytopenia]]
**[[Altered mental status]]

==PD1 Monoclonal Antibodies==
===Pembrolizumab (Keytruda)===
*A PD-1 humanized mouse mAb
*Adverse events include:
**Infusion reactions
**Musculoskeletal pain
**Dyspnea
**Diarrhea
*(Arrhythmias
*(Myocardial infarctions
*(Pericardial effusions

===Nivolumab (OPDIVO)===
*A PD-1 human IgG4 mAb
*Adverse events include:
**[[Graft-vs-host disease]]
**[[Portal vein thrombosis]]


==Small molecule inhibitors==
===Enasidenib (IDHIFA)===
*Adverse Events:
**[[Jaundice|Indirect hyperbilirubinemia]]
**[[Differentiation syndrome]]


===Ivosidenib (Tibsovo)===
*Adverse events
**[[QT prolongation]] 
**[[Leukocytosis]]
**[[Differentiation syndrome]]

===Midostaurin (Rydapt)===
*Adverse Events:
**[[Febrile neutropenia]]
**[[Mucositis]]
**[[Nausea and vomiting]]
**[[Headache]]
**[[Petechiae]]
*[[Epistaxis]]
**[[URI]]

===Nilotinib (Tasigna)===
*Adverse events
**[[QT prolongation]]
**Sudden death 
**Myelosuppression
**[[Arterial thrombosis]]
**[[Pancreatitis]]
**[[Hepatotoxicity]]

===Bosutinib (Bosulif)===
*Adverse Events:
**Myelosuppression
**[[Diarrhea]]
**[[Pancreatitis]]
**[[Hepatotoxicity]] 
**[[Cardiac arrest]]
**[[Arrythmia]]
**[[ACS]]

===Ibrutinib (Imbruvica)===
*Adverse Events:
**[[Cytopenia|Cytopenias]]
**[[Hypertension]]


===Acalabrutinib (Calquence)===
*Adverse Events:
**[[Headache]]
**[[Diarrhea]]
**[[Myalgia]]
**[[Neutropenia]]
**[[Anemia]]
**[[Pneumonia]]
**[[ACS]]

===Duvelisib (Copiktra)===
*Adverse Events:
**[[Nausea]]
**[[Diarrhea]] 
**[[Pyrexia]]
**[[Cytopenia]]

===Copanlisib (Aliqopa)===
*Adverse Events:
**[[Hyperglycemia]]
**[[Hypertension]]
**[[Sepsis]]
**[[Neutropenia]]
**[[Pneumonitis]]


===Panobinostat lactate (Farydak)===
*Adverse Events:
**[[Cytopenia]]
**[[Diarrhea]]
**[[Peripheral neuropathy]]

===Ixazomib citrate (Ninlaro)===
*Adverse Events:
**[[Cytopenias]] 
**[[Vomiting]]
**[[Diarrhea]]
**[[Constipation]]
**[[Neuropathy]]
**[[Peripheral edema]]
**[[Back pain]]

===Venetoclax (Venclexta)===
*Adverse Events:
**[[Tumor lysis syndrome]]
**Bone marrow suppression
**[[Autoimmune hemolytic anemia]]

==Monoclonal antibodies against cell surface antigens==
===Ofatumumab (Arzerra)===
*Adverse Events:
**Reactivation of [[Hepatitis B]] virus infection 
**[[Progressive multifocal leukoencephalopathy]] 
**[[Tumor lysis syndrome]]
**[[Infusion reaction]]
**[[Cytopenias]]


===Obinutuzumab (Gazyva)===
*Adverse Events:
**[[Neutropenic Fever]]
**[[Thrombocytopenia]]
**[[Infusion Reactions]]


===Daratumumab (Darzalex)===
*Adverse Events:
**[[Cytopenia]]
**[[Diarrhea]]
**[[Pneumonia]]

===Elotuzumab (Empliciti)===
*Adverse Events:
**[[Pyrexia]]
**[[Anemia]]
**[[Pneumonia]]
**[[Pulmonary embolism]]
**[[Acute renal failure]]
**[[Hepatotoxicity]]

===Empliciti (Poteligeo)===
*Adverse Events:
**[[GVHD]]
**[[Rash]]

==Antibody-drug conjugates==
===Inotuzumab ozogamicin (Besponsa)===
*Adverse Events:
**[[Sinusoid occlusion syndrome]]
**Infusion reactions
**[[Thrombocytopenia]]
**[[Neutropenia]]
**[[QT prolongation]]


===Gemtuzumab ozogamicin (Mylotarg)===
*Adverse Events:
**[[Thrombocytopenia]]
**Abnormal [[LFTs]]
**Veno-oclusions

===Brentuximab vedotin (Adcetris)===
*Adverse Events:
**[[Progressive multifocal leukoencephalopathy]]
**[[Peripheral neuropathy]]
**[[Bone marrow suppression]]

==Immunotoxin==
===Moxetumomab pasudotox-tdfk (Lumoxiti)===
*Adverse Events:
**[[Hemolytic uremic syndrome]]
**[[Capillary leak syndrome]]

==Bispecific T-cell engager (Blincyto)==
===Blinatumomab===
*Adverse Events:
**[[Altered mental status]]
**[[Cytokine release syndrome]]

==Disposition==
*Most of these patients should be admitted and coordination should occur with hematology/oncology

==See Also==
*[[Biologic immunomodulators]]

==External Links==


==References==
<references/>

[[Category:Heme/Onc]]