A Wolf in Sheep's Clothing: Systemic Immune Activation Post Immunotherapy.

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ICR Authors

Tiu, Crescens
 Tunariu, Nina
 Banerji, Udai
 De Bono, Johann
 Minchom, Anna
 Lopez, Juanita

Authors

Tiu, C
Shinde, R
Pal, A
Biondo, A
Lee, A
Tunariu, N
Jhanji, S
Grover, V
Tatham, K
Gruber, P
Banerji, U
De Bono, JS
Nicholson, E
Minchom, AR
Lopez, JS

Document Type

Journal Article

Date

2021-11-01

Date Accepted

2021-07-09

Abstract

INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly a standard of care for many cancers; these agents can result in immune-related adverse events (irAEs) including fever, which is common but can rarely be associated with systemic immune activation (SIA or acquired HLH). METHODS: All consecutive patients receiving ICIs in the Drug Development Unit of the Royal Marsden Hospital between May 2014 and November 2019 were retrospectively reviewed. Patients with fever ≥ 38°C or chills/rigors (without fever) ≤ 6 weeks of commencing ICIs were identified for clinical data collection. RESULTS: Three patients met diagnostic criteria for SIA/HLH with median time to onset of symptoms of 10 days. We describe the clinical evolution, treatment used, and outcomes for these patients. High-dose steroids are used first-line with other treatments, such as tocilizumab, immunoglobulin and therapeutic plasmapheresis can be considered for steroid-refractory SIA/HLH. CONCLUSION: SIA/HLH post ICI is a rare but a potentially fatal irAE that presents with fever and a constellation of nonspecific symptoms. Early recognition and timely treatment are key to improving outcomes.

Citation

J Immunother Precis Oncol, 2021, 4 (4), pp. 189 - 195

DOI

10.36401/JIPO-21-9

URI

https://repository.icr.ac.uk/handle/internal/5445

Rights

http://creativecommons.org/licenses/by/4.0/

Source Title

J Immunother Precis Oncol

Publisher

Innovative Healthcare Institute

ISSN

2666-2345

eISSN

2590-017X
2590-017X

Collections

Breast Cancer Research

Research Team

Cell Death and Immunity
Clinical Pharmacology
PrCa Targeted Therapy
Adult DDU ICR & RM
Early Phase Drug Develop

Notes