Podcast 577:  Immunotherapies

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Checkpoint inhibition normally helps our body detect abnormal cells and terminate it but cancerous cells often are able to avoid this countermeasure</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Monoclonal antibodies that bind to checkpoint inhibitors can stop cancerous cells from turning off immunologic T cells and allows the immune system to continue to attack cancers.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">These therapies carry risks of exacerbating autoimmune problems due to the ramped up immune response</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Most often this autoimmune attack leads to skin and GI symptoms but can affect many other organ systems. In the emergency room this can present many different ways, but the mainstay of treatment is steroids to stop these exacerbations.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Chimeric Antigen Receptor (CAR) T-cell Therapy is another immunotherapy where antigens to a cancerous cell are re-introduced to spur a directed immune response</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Cytokine release syndrome can occur in these patients and mimic other presentations such as septic shock, a result of tumor break down</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">This is treated with steroids and monoclonal antibodies that help thwart the cytokine release</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Hay, KA. Cytokine release syndrome and neurotoxicity after CD19 chimeric antigen re</span><span style= "font-weight: 400;">ceptor-modified (CAR-) T cell therapy. Br J Haematol. 2018 Nov;183(3):364-374. doi: 10.1111/bjh.15644. Epub 2018 Nov 8.</span></span></p> <p