Managing Complications in Cancer Immunotherapy in Head and Neck Cancer

Donovan Eu ； Chwee Ming Lim

《International Journal of Head and Neck Science》 2卷3期 (2018/09) Pp. 107-117

https://doi.org/10.6696/IJHNS.201809_2(3).0003

摘要

Immunotherapy is touted as the fourth pillar in the treatment of cancer because of the increased understanding of the immune tumor microenvironment; and the durable clinical responses seen in patients treated with both checkpoint inhibitors and cellular based therapy. In head and neck squamous cancer (HNC), immunotherapy is increasingly pursued in clinical trials, especially in patients with refractory loco-regional recurrent and/or metastatic disease. Cancer immunotherapy aims either to enhance the host immune system to eradicate the cancer cells, and/or remove immune tolerance effects against cancer through immune pathways such as the programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) axis. Manipulation of these immune responses is not without inherent risks, and may lead to uncontrolled activation of the immune system against the host; and often “on-target, non-tumor” effects to normal tissues due to shared tumor associated antigens. While most of these complications may be managed effectively, some patients do suffer organ damage and a small subset may succumb to these complications. Most of these complications typically mimic patients with autoimmune disease. Interestingly, the different types of immunotherapy agents are more often related to specific adverse event presentations, such as gastrointestinal complications in patients treated with cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors. While the exact mechanisms of these adverse reactions are still under investigations, several pathways have been proposed. In this review, the common complications of cancer immunotherapy are presented along with their proposed mechanism(s); discussion of the interventions and preventions of these complications are presented.

關鍵字

immunotherapy ； checkpoint inhibitors ； immune-related adverse events ； adoptive cell therapy ； cytokine release syndrome