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World J Clin Oncol. Mar 24, 2021; 12(3): 150-163
Published online Mar 24, 2021. doi: 10.5306/wjco.v12.i3.150
Systemic adverse effects and toxicities associated with immunotherapy: A review
Asim Kichloo, Michael Albosta, Dushyant Dahiya, Jean Claude Guidi, Michael Aljadah, Jagmeet Singh, Hafeez Shaka, Farah Wani, Akshay Kumar, Manidhar Lekkala
Asim Kichloo, Michael Albosta, Dushyant Dahiya, Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
Asim Kichloo, Jean Claude Guidi, Department of Internal Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
Michael Aljadah, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53201, United States
Jagmeet Singh, Department of Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Hafeez Shaka, Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
Farah Wani, Department of Family Medicine, Samaritan Medical Center, Watertown, NY 13601, United States
Akshay Kumar, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, United States
Manidhar Lekkala, Department of Hematology and Oncology, University of Rochester Medical Center, Rochester, NY 14642, United States
Author contributions: All authors have contributed to the manuscript and agree with the final version of the manuscript. Kichloo A and Dahiya DS are credited with substantial contribution to the design of the work, literature review of all the sections discussed, the revision of critically important intellectual content, final approval of the published version, and agreement of accountability for all aspects of the work; Albosta M, Guidi JC, Singh J, Aljadah M, Shaka H, and Wani F are credited with significant design of the tables and graphs, literature review of all sections, drafting of the manuscript, revision of important intellectual content for the discussion, and agreement of accountability for all parts of the work; Kumar A and Lekkala M is credited with assisting in literature review, final content write up and agreement of accountability for all aspects of the work.
Conflict-of-interest statement: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Albosta, MD, Doctor, Department of Internal Medicine, Central Michigan University, 1000 Houghton Ave, Saginaw, MI 48603, United States. albos1ms@cmich.edu
Received: November 3, 2020
Peer-review started: November 3, 2020
First decision: January 11, 2021
Revised: January 21, 2021
Accepted: February 19, 2021
Article in press: February 19, 2021
Published online: March 24, 2021
Abstract

Immunotherapy is rapidly evolving secondary to the advent of newer immunotherapeutic agents and increasing approval of the current agents by the United States Food and Drug Administration to treat a wide spectrum of cancers. Immunotherapeutic agents have gained immense popularity due to their tumor-specific action. Immunotherapy is slowly transforming into a separate therapeutic entity, and the fifth pillar of management for cancers alongside surgery, radiotherapy, chemotherapy, and targeted therapy. However, like any therapeutic entity it has its own adverse effects. With the increasing use of immuno-therapeutic agents, it is vital for physicians to acquaint themselves with these adverse effects. The aim of this review is to investigate the common systemic adverse effects and toxicities associated with the use of different classes of immunotherapeutic agents. We provide an overview of potential adverse effects and toxicities associated with different classes of immunotherapeutic agents organized by organ systems, as well as an extensive discussion of the current recommendations for treatment and clinical trial data. As we continue to see increasing usage of these agents in clinical practice, it is vital for physicians to familiarize themselves with these effects.

Keywords: Immunotherapy, Cancer, Malignancy, Adverse effects, Immune checkpoint inhibitor, Monoclonal antibody

Core Tip: While immunotherapy is widely becoming a popular therapeutic treatment modality for a broad range of malignancies, it also has been known to cause a number of adverse effects. These effects have been found to be prevalent in a large number of organ systems. Clinicians should be aware of the various adverse effects associated with these novel therapeutic agents, as well as recommendations for management of these side effects in order to facilitate improved outcomes for patients undergoing these therapies.