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Evidence-based Advance and Management of Adverse Events of Immunotherapy for Cancer

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Immunotherapy, which activates the body’s immune system, has drawn great attention in recent years due to its significant effects. It has been more than 100 years since the first immunotherapy report in 1911 by Leonard Noon. In 1954, Frankland reported the first double-blind placebo-controlled randomized ...

Immunotherapy, which activates the body’s immune system, has drawn great attention in recent years due to its significant effects. It has been more than 100 years since the first immunotherapy report in 1911 by Leonard Noon. In 1954, Frankland reported the first double-blind placebo-controlled randomized trial in immunotherapy. Since then, immunotherapy has been utilised in different diseases, including asthma and reactions to skin allergens.

Harnessing the immune system for therapeutic benefit in cancer has long been an aim of immunologists and oncologists. In the past 20 years, great progress has been achieved. Notably, the Nobel Prize in Physiology or Medicine 2018 was awarded jointly to James P. Allison and Tasuku Honjo "for their discovery of cancer therapy by inhibition of negative immune regulation." Immunotherapy has become an important approach for treating different cancers in numerous clinical trials. The FDA has approved several immunotherapeutic drugs for cancers, such as ipilimumab for the use in advanced melanoma. Moreover, other emerging therapies such as the chimeric-antigen receptor T-cell adoptive immunotherapy (CAR-T) has shown remarkable efficacy. Despite the advances in immunotherapy in cancer, toxicities and drug-induced adverse events have been observed. These toxicities are commonly referred to as immune-related adverse events (irAE). IrAEs might consist of, but are not limited to, dermatologic, gastrointestinal (diarrhea, colitis), hepatic, endocrine (thyroid dysfunction, hypophysitis, adrenal crisis), renal, ocular and pulmonary toxicity. In addition, new patterns of radiological response have been observed in patients treated with immune checkpoint inhibitors (ICIs). These adverse events can affect multiple organs and their presentation can range from mild and manageable, to severe and life-threatening.

Clinical trials with a short time follow-up limit the understanding of long-term adverse events and side effects of immunotherapy. We do not know much yet about the adverse events that the survivors are experiencing or susceptible to. New approaches capable of improving the management of adverse events may not be conclusive.

Some new evidence that can contribute to the avoidance and management of adverse events has been published in recent years. Steroid therapy, a critical component of the treatment in emergency departments, is administered at high doses and for prolonged periods to switch off immune over-activation. Preventing multi-organ failure and fatality, and allowing patients to remain on effective anti-cancer therapy are also important. It is urgent to interpret the newly reported adverse events for various cancers. This knowledge will guide more effective and safer clinical practice, rational therapy development, and justifiable policy-making in immunotherapy.

This Research Topic will include studies on new advances and management of adverse events of immunotherapy for cancer, and will welcome Original Clinical research, Review articles, Systematic Reviews, and meta-analysis reporting recent advances and management of the adverse events of cancer immunotherapy. Adverse events can include all immunotherapy methods, and the combination of immunotherapy with other therapies.


Keywords: Evidence-based, immunotherapy, cancer, adverse event, management


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