Diferencia entre revisiones de «Oncologic therapy related adverse events»
| (No se muestran 12 ediciones intermedias de otro usuario) | |||
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**Acute lymphoblastic leukemia | **Acute lymphoblastic leukemia | ||
**Large B-cell lymphoma | **Large B-cell lymphoma | ||
*Adverse events include: | |||
**[[Cytokine release syndrome]] | **[[Cytokine release syndrome]] | ||
**[[Pancytopenia]] | **[[Pancytopenia]] | ||
| Línea 45: | Línea 45: | ||
**Dyspnea | **Dyspnea | ||
**Diarrhea | **Diarrhea | ||
* | *(Arrhythmias | ||
* | *(Myocardial infarctions | ||
* | *(Pericardial effusions | ||
===Nivolumab (OPDIVO)=== | ===Nivolumab (OPDIVO)=== | ||
| Línea 58: | Línea 58: | ||
==Small molecule inhibitors== | ==Small molecule inhibitors== | ||
===Enasidenib (IDHIFA)=== | ===Enasidenib (IDHIFA)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Jaundice|Indirect hyperbilirubinemia]] | **[[Jaundice|Indirect hyperbilirubinemia]] | ||
*[[Differentiation syndrome]] | **[[Differentiation syndrome]] | ||
===Ivosidenib (Tibsovo)=== | ===Ivosidenib (Tibsovo)=== | ||
Adverse events | *Adverse events | ||
*[[QT prolongation]] | **[[QT prolongation]] | ||
*[[Leukocytosis]] | **[[Leukocytosis]] | ||
*[[Differentiation syndrome]] | **[[Differentiation syndrome]] | ||
===Midostaurin (Rydapt)=== | ===Midostaurin (Rydapt)=== | ||
Adverse Events: | *Adverse Events: | ||
**[[Febrile neutropenia]] | **[[Febrile neutropenia]] | ||
**[[Mucositis]] | **[[Mucositis]] | ||
| Línea 81: | Línea 80: | ||
===Nilotinib (Tasigna)=== | ===Nilotinib (Tasigna)=== | ||
Adverse events | *Adverse events | ||
*[[QT prolongation]] | **[[QT prolongation]] | ||
*Sudden death | **Sudden death | ||
*Myelosuppression | **Myelosuppression | ||
*[[Arterial thrombosis]] | **[[Arterial thrombosis]] | ||
*[[Pancreatitis]] | **[[Pancreatitis]] | ||
*[[Hepatotoxicity]] | **[[Hepatotoxicity]] | ||
===Bosutinib (Bosulif)=== | ===Bosutinib (Bosulif)=== | ||
Adverse Events: | *Adverse Events: | ||
*Myelosuppression | **Myelosuppression | ||
*[[Diarrhea]] | **[[Diarrhea]] | ||
*[[Pancreatitis]] | **[[Pancreatitis]] | ||
*[[Hepatotoxicity]] | **[[Hepatotoxicity]] | ||
*[[Cardiac arrest]] | **[[Cardiac arrest]] | ||
*[[Arrythmia]] | **[[Arrythmia]] | ||
*[[ACS]] | **[[ACS]] | ||
===Ibrutinib (Imbruvica)=== | ===Ibrutinib (Imbruvica)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Cytopenia|Cytopenias]] | **[[Cytopenia|Cytopenias]] | ||
*[[Hypertension]] | **[[Hypertension]] | ||
===Acalabrutinib (Calquence)=== | ===Acalabrutinib (Calquence)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Headache]] | **[[Headache]] | ||
*[[Diarrhea]] | **[[Diarrhea]] | ||
*[[Myalgia]] | **[[Myalgia]] | ||
*[[Neutropenia]] | **[[Neutropenia]] | ||
*[[Anemia]] | **[[Anemia]] | ||
*[[Pneumonia]] | **[[Pneumonia]] | ||
*[[ACS]] | **[[ACS]] | ||
===Duvelisib (Copiktra)=== | ===Duvelisib (Copiktra)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Nausea]] | **[[Nausea]] | ||
*[[Diarrhea]] | **[[Diarrhea]] | ||
*[[Pyrexia]] | **[[Pyrexia]] | ||
*[[Cytopenia]] | **[[Cytopenia]] | ||
===Copanlisib (Aliqopa)=== | ===Copanlisib (Aliqopa)=== | ||
*[[Hyperglycemia]] | *Adverse Events: | ||
*[[Hypertension]] | **[[Hyperglycemia]] | ||
*[[Sepsis]] | **[[Hypertension]] | ||
*[[Neutropenia]] | **[[Sepsis]] | ||
*[[Pneumonitis]] | **[[Neutropenia]] | ||
**[[Pneumonitis]] | |||
===Panobinostat lactate (Farydak)=== | ===Panobinostat lactate (Farydak)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Cytopenia]] | **[[Cytopenia]] | ||
*[[Diarrhea]] | **[[Diarrhea]] | ||
*[[Peripheral neuropathy]] | **[[Peripheral neuropathy]] | ||
===Ixazomib citrate (Ninlaro)=== | ===Ixazomib citrate (Ninlaro)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Cytopenias]] | **[[Cytopenias]] | ||
*[[Vomiting]] | **[[Vomiting]] | ||
*[[Diarrhea]] | **[[Diarrhea]] | ||
*[[Constipation]] | **[[Constipation]] | ||
*[[Neuropathy]] | **[[Neuropathy]] | ||
*[[Peripheral edema]] | **[[Peripheral edema]] | ||
*[[Back pain]] | **[[Back pain]] | ||
===Venetoclax (Venclexta)=== | ===Venetoclax (Venclexta)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Tumor lysis syndrome]] | **[[Tumor lysis syndrome]] | ||
*Bone marrow suppression | **Bone marrow suppression | ||
*[[Autoimmune hemolytic anemia]] | **[[Autoimmune hemolytic anemia]] | ||
==Monoclonal antibodies against cell surface antigens== | ==Monoclonal antibodies against cell surface antigens== | ||
===Ofatumumab (Arzerra)=== | ===Ofatumumab (Arzerra)=== | ||
Adverse Events: | *Adverse Events: | ||
*Reactivation of [[Hepatitis B]] virus infection | **Reactivation of [[Hepatitis B]] virus infection | ||
*[[Progressive multifocal leukoencephalopathy]] | **[[Progressive multifocal leukoencephalopathy]] | ||
*[[Tumor lysis syndrome]] | **[[Tumor lysis syndrome]] | ||
*[[Infusion reaction]] | **[[Infusion reaction]] | ||
*[[Cytopenias]] | **[[Cytopenias]] | ||
===Obinutuzumab (Gazyva)=== | ===Obinutuzumab (Gazyva)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Neutropenic Fever]] | **[[Neutropenic Fever]] | ||
*[[Thrombocytopenia]] | **[[Thrombocytopenia]] | ||
*[[Infusion Reactions]] | **[[Infusion Reactions]] | ||
===Daratumumab (Darzalex)=== | ===Daratumumab (Darzalex)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Cytopenia]] | **[[Cytopenia]] | ||
*[[Diarrhea]] | **[[Diarrhea]] | ||
*[[Pneumonia]] | **[[Pneumonia]] | ||
===Elotuzumab (Empliciti)=== | ===Elotuzumab (Empliciti)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[Pyrexia]] | **[[Pyrexia]] | ||
*[[Anemia]] | **[[Anemia]] | ||
*[[Pneumonia]] | **[[Pneumonia]] | ||
*[[Pulmonary embolism]] | **[[Pulmonary embolism]] | ||
*[[Acute renal failure]] | **[[Acute renal failure]] | ||
*[[Hepatotoxicity]] | **[[Hepatotoxicity]] | ||
===Empliciti (Poteligeo)=== | ===Empliciti (Poteligeo)=== | ||
Adverse Events: | *Adverse Events: | ||
*[[GVHD]] | **[[GVHD]] | ||
*[[Rash]] | **[[Rash]] | ||
==Antibody-drug conjugates== | ==Antibody-drug conjugates== | ||
===Inotuzumab ozogamicin (Besponsa)=== | ===Inotuzumab ozogamicin (Besponsa)=== | ||
*Adverse Events: | |||
**[[Sinusoid occlusion syndrome]] | |||
**Infusion reactions | |||
**[[Thrombocytopenia]] | |||
**[[Neutropenia]] | |||
**[[QT prolongation]] | |||
===Gemtuzumab ozogamicin (Mylotarg)=== | ===Gemtuzumab ozogamicin (Mylotarg)=== | ||
*Adverse Events: | |||
**[[Thrombocytopenia]] | |||
**Abnormal [[LFTs]] | |||
**Veno-oclusions | |||
===Brentuximab vedotin (Adcetris)=== | ===Brentuximab vedotin (Adcetris)=== | ||
*Adverse Events: | |||
**[[Progressive multifocal leukoencephalopathy]] | |||
**[[Peripheral neuropathy]] | |||
**[[Bone marrow suppression]] | |||
==Immunotoxin== | ==Immunotoxin== | ||
===Moxetumomab pasudotox-tdfk (Lumoxiti)=== | ===Moxetumomab pasudotox-tdfk (Lumoxiti)=== | ||
*Adverse Events: | |||
**[[Hemolytic uremic syndrome]] | |||
**[[Capillary leak syndrome]] | |||
==Bispecific T-cell engager (Blincyto)== | ==Bispecific T-cell engager (Blincyto)== | ||
===Blinatumomab=== | ===Blinatumomab=== | ||
*Adverse Events: | |||
**[[Altered mental status]] | |||
**[[Cytokine release syndrome]] | |||
==Disposition== | ==Disposition== | ||
*Most of these patients should be admitted and coordination should occur with hematology/oncology | |||
==See Also== | ==See Also== | ||
Revisión actual - 00:21 15 dic 2020
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.[1]
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
- 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
- Decreased cellular immunity which an cause reactivation or new
- Neurologic syndromes
- Hematologic side effects
- Cardiac effects
- Allergic reactions
- Pulmonary
- Endocrine
- GI
- Perforations
- Clostridium difficile
- Acute bacterial infections
- Malignancies
- Non-melanoma skin cancers
- Lymphoma
CAR-T cells medications
Tisagenlecleucel (Kymriah)
- Indications:
- Acute lymphoblastic leukemia
- Large B-cell lymphoma
- Adverse events include:
Axicabtagene ciloleucel (Yescarta)
- Indications:
- Acute lymphoblastic leukemia
- Large B-cell lymphoma
- Adverse events include:
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:
Small molecule inhibitors
Enasidenib (IDHIFA)
- Adverse Events:
Ivosidenib (Tibsovo)
- Adverse events
Midostaurin (Rydapt)
- Adverse Events:
- Epistaxis
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:
Acalabrutinib (Calquence)
Duvelisib (Copiktra)
Copanlisib (Aliqopa)
- Adverse Events:
Panobinostat lactate (Farydak)
- Adverse Events:
Ixazomib citrate (Ninlaro)
- Adverse Events:
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:
Daratumumab (Darzalex)
Elotuzumab (Empliciti)
- Adverse Events:
Empliciti (Poteligeo)
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:
Immunotoxin
Moxetumomab pasudotox-tdfk (Lumoxiti)
- Adverse Events:
Bispecific T-cell engager (Blincyto)
Blinatumomab
- Adverse Events:
Disposition
- Most of these patients should be admitted and coordination should occur with hematology/oncology
See Also
External Links
References
- ↑ 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