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Cardiotoxicity of immunotherapy in lung cancer in light of new ESC guidelines

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Orzeł G. B., Łydka M., Lewandowska J., Stachowiak J., Szymańska E., Mizia-Stec K.
Annales Academiae Medicae Silesiensis
|
2023
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issue 77
137-145
EN
There has been rapid development of anticancer therapies involving monoclonal antibodies targeting immune checkpoints of the immune response. One of them is pembrolizumab (the anti-programmed death receptor 1 ligand – anti-PD-1) used in the treatment of malignant melanoma, non-small cell lung cancer, or triple-negative breast cancer, among others. The case presented in this paper refers to a patient suffering from adenocarcinoma of the lung with multiple metastases and associated diseases. During immunotherapy with pembrolizumab, acute myocarditis was diagnosed. The clinical course of this case study specifically demonstrates how important, in the context of oncology patients treated with immunotherapy, the continuous evaluation and control are of the occurrence of adverse toxic effects associated with anticancer treatment. First of all, potential PD-1 inhibitor cardiotoxicity is rare in patients undergoing therapy with this drug, which significantly hinders accurate differential diagnosis in this direction. Second, this adverse effect, although relatively rare, is often fatal. The following case study describes how, with high doses of glucocorticosteroids, the effects of pembrolizumab-induced toxicity can be effectively muted.
PL
Obserwuje się dynamiczny rozwój terapii przeciwnowotworowej z udziałem przeciwciał monoklonalnych ukie-runkowanych na odpornościowe punkty kontroli odpowiedzi immunologicznej. Jednym z nich jest pembroli-zumab (humanizowane przeciwciało skierowane przeciwko receptorowi programowanej śmierci komórki 1 – anty-PD-1), stosowany w leczeniu m.in. czerniaka złośliwego, niedrobnokomórkowego raka płuc czy potrójnie ujemnego raka piersi. Przedstawiony w niniejszej pracy przypadek kliniczny dotyczy pacjenta chorującego na raka gruczołowego płuca z licznymi przerzutami oraz chorobami towarzyszącymi. W trakcie immunoterapii pembrolizumabem rozpoznano ostre zapalenie mięśnia sercowego. Przebieg kliniczny tej choroby w sposób szczególny wskazuje na to, jak istotna u pacjentów onkologicznych leczonych immunoterapią jest ciągła oce-na i kontrolowanie niepożądanych efektów toksycznych związanych z leczeniem przeciwnowotworowym. Po pierwsze, potencjalna kardiotoksyczność inhibitora PD-1 występuje rzadko u pacjentów poddanych terapii tym lekiem, co znacznie utrudnia precyzyjną diagnostykę różnicową w tym kierunku. Po drugie, ten niepożądany efekt, choć występuje stosunkowo rzadko, często jest śmiertelny. Opisany przypadek wskazuje, w jaki sposób za pomocą wysokich dawek glikokortykosteroidów można skutecznie wyciszać efekty toksyczności wywołanej przez pembrolizumab.
2
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Immunotherapy of head and neck squamous cell carcinoma (HNSCC). Immune checkpoint blockade

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Przybylski K., Majchrzak E., Weselik L., Golusiński W.
Otolaryngologia Polska
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2018
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vol. 72(6)
10-16
EN
Treating patients with squamous cell carcinoma of the head and neck is a significant problem. There is an increase in the incidence of malignant neoplasms in this region. Surgery, radiotherapy and chemotherapy are often not sufficient methods of treatment. Thorough analysis of processes occurring in the tumor microenvironment has allowed to distinguish three stages that make up the reaction of the human body to hostile antigens, which are tumor antigens. Understanding these mechanisms has resulted in the introduction of a new term immune-oncology. It is an area of cancer treatment that focuses on use of the patient’s immune system to combat the disease. Immunotherapy has had positive effects in cancer patients. The use of immune checkpoint inhibitors, such as anti-CTLA-4 and PD-1 monoclonal antibodies has enabled the modulation of T cell functions, consequently eliminating immunosuppression in the tumor microenvironment. Clinical trials were conducted using nivolumab and ipilimumab, which confirmed their clinical usefulness. The approval by FDA of nivolumab in treatment of recurrent and metastatic squamous cell carcinoma of the head and neck has increased the overall survival time of patients as well as disease free survival. Statistical data indicate an advantage of immunotherapy over other treatment methods at an advanced stage of cancer. This work aims to discuss basic issues related to immunotherapy, in particular immunotherapy in patients with squamous cell carcinoma of the head and neck.
3
Publication available in full text mode
Content available

Immunotherapy of head and neck squamous cell carcinoma (HNSCC). Immune checkpoint blockade

100%
Przybylski K., Majchrzak E., Weselik L., Golusiński W.
|
EN
Treating patients with squamous cell carcinoma of the head and neck is a significant problem. There is an increase in the incidence of malignant neoplasms in this region. Surgery, radiotherapy and chemotherapy are often not sufficient methods of treatment. Thorough analysis of processes occurring in the tumor microenvironment has allowed to distinguish three stages that make up the reaction of the human body to hostile antigens, which are tumor antigens. Understanding these mechanisms has resulted in the introduction of a new term immune-oncology. It is an area of cancer treatment that focuses on use of the patient’s immune system to combat the disease. Immunotherapy has had positive effects in cancer patients. The use of immune checkpoint inhibitors, such as anti-CTLA-4 and PD-1 monoclonal antibodies has enabled the modulation of T cell functions, consequently eliminating immunosuppression in the tumor microenvironment. Clinical trials were conducted using nivolumab and ipilimumab, which confirmed their clinical usefulness. The approval by FDA of nivolumab in treatment of recurrent and metastatic squamous cell carcinoma of the head and neck has increased the overall survival time of patients as well as disease free survival. Statistical data indicate an advantage of immunotherapy over other treatment methods at an advanced stage of cancer. This work aims to discuss basic issues related to immunotherapy, in particular immunotherapy in patients with squamous cell carcinoma of the head and neck.
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