Immun related adverse effects of immun checkpoint inhibitors

Delineation of the interaction between cancer and the host immune system leads to development of the immunotherapies, immune checkpoint inhibitors in particular, in the last decade. Tough immunotherapies are currently not reimbursed by authorities in Turkey and only patients could reach to thisagents via clinical trials, they have been increasingly used and reimbursed in the most of the western countries including USA. Immonutherapeutics agents have low toxicity profile when compared to cytotoxic chemotherapeutics, while their side effects can occur in unpredictable time (any time during treatment), require high clinical suspicion and extensive search for the differential diagnosis. Theoretically, any organ can be affected but skin, gastrointestinal, lung and endocrine system are most frequently effected organs in pivotal trials 11,12. Most side effects are related to overreaction the host immune system and named as 'immune related adverse events' irAE 6. This unique side effect profile can be challenging for the Medical Oncologist in their clinical practice 8,13. The aim of this study is the evaluation of the metabolic side effects of certain immunotherapeutic agents like ipilimumab, nivolumab, and pembrolizumab which were mostly used in the context of clinical trials. The research data was performed by scanning from the electronic or paper-based patient files. This study was designedas a retrospective case-control study. Laboratory parameters of 34 patients with renal cell carcinoma, malignant melanoma and advanced non-small cell lung carcinoma (RCC) were analysed. Totally 34 patients received ipilimumab, nivolumab or pembrolizumab (12, 16, 6 patients, respectively). No severe side effects, drug interruption or drug cessation were observed. Most of the adverse effects were related to liver (%11) and thyroid (%17,6) functions and also metabolic (%6) and electrolyte (%14,7) changes were observed. Most common adverse effects observed in patients received ipilimumab were liver toxicity (%25) and electrolytedysfunctions (%25);in patients received pembrolizumab was thyroid dysfonctions (%33);in patients received nivolumab was diyabet (%13). Most oftheseare mild but it is important to consider these data from a small number of clinical study patients until the date of publication of large studies in whichreal life data are available.