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      Immune manifestations with checkpoint inhibitors in a single Brazilian center: experience and literature review


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          The presence of autoimmune events were recorded in patients receiving immune checkpoint inhibitors.

          Materials & Methods:

          Retrospective study in patients receiving immune checkpoint inhibitors (ICIs) during the period of 2012–2019.


          A total of 554 patients received ICIs of which 123 developed an immune related adverse event. Twenty one (17%) with toxicity were identified as having a pre-existing autoimmune disease and 88 required treatment with corticosteroids or hormone replacement. Thirty two (26%) out of 123 had to temporarily discontinue ICIs due to autoimmune manifestations. Endocrine and skin manifestations were the most prevalent immune disorders in our cohort. In melanoma better efficacy was seen in patients with immune toxicity.


          Autoimmune diseases appear in patients receiving ICIs in this real world experience. Our results differ from other series on the frequency of autoimmunity. Complete discontinuation of ICIs due to autoimmunity was rare.

          Lay abstract

          The development of autoimmune events in patients receiving the modern forms of cancer immunotherapy are not unexpected since the presence of robust immune response against tumors relies on mechanisms of T-cell activation and release of cytotoxic cytokines that can also mediate autoimmune inflammatory conditions. In fact, some studies including ours points to better efficacy against tumor in patients that also develop autoimmune toxicity. Cancer therapy has now five consolidated forms of treatment, Chemotherapy, Radiotherapy, Surgery Biologic Therapy and second generation Immunotherapy.

          Most cited references33

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          Immune-Related Adverse Events Associated with Immune Checkpoint Blockade

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            The future of immune checkpoint therapy.

            Immune checkpoint therapy, which targets regulatory pathways in T cells to enhance antitumor immune responses, has led to important clinical advances and provided a new weapon against cancer. This therapy has elicited durable clinical responses and, in a fraction of patients, long-term remissions where patients exhibit no clinical signs of cancer for many years. The way forward for this class of novel agents lies in our ability to understand human immune responses in the tumor microenvironment. This will provide valuable information regarding the dynamic nature of the immune response and regulation of additional pathways that will need to be targeted through combination therapies to provide survival benefit for greater numbers of patients.
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              Immune checkpoint blockade: a common denominator approach to cancer therapy.

              The immune system recognizes and is poised to eliminate cancer but is held in check by inhibitory receptors and ligands. These immune checkpoint pathways, which normally maintain self-tolerance and limit collateral tissue damage during anti-microbial immune responses, can be co-opted by cancer to evade immune destruction. Drugs interrupting immune checkpoints, such as anti-CTLA-4, anti-PD-1, anti-PD-L1, and others in early development, can unleash anti-tumor immunity and mediate durable cancer regressions. The complex biology of immune checkpoint pathways still contains many mysteries, and the full activity spectrum of checkpoint-blocking drugs, used alone or in combination, is currently the subject of intense study. Copyright © 2015 Elsevier Inc. All rights reserved.

                Author and article information

                Future Sci OA
                Future Sci OA
                Future Science OA
                Future Science Ltd (London, UK )
                23 November 2020
                January 2021
                23 November 2020
                : 7
                : 1
                : FSO655
                [1 ]Oncology Center & Center for Autoimmune Diseases at Hospital A Beneficência Portuguesa, São Paulo, Brazil
                Author notes
                [* ]Author for correspondence: morton@ 123456osite.com.br
                Author information
                © 2020 Morton Scheinberg

                This work is licensed under the Creative Commons Attribution 4.0 License

                : 14 July 2020
                : 02 October 2020
                : 23 November 2020
                Page count
                Pages: 8
                Short Communication

                autoimmune disease,checkpoint inhibitors,endocrine system,immunotherapy,malignant melanoma,tumor


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