Multispecialty Spotlight

Multi-specialty Spotlight

Questions discussed in this category

Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?

2 Answers available

Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?

2 Answers available

How do you approach dosing of anakinra in MAS?

1 Answer available

For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?

2 Answers available

How do you approach diagnosis and treatment of HLH/MAS following CAR T-cell therapy?

How is this entity distinct from other secondary HLH entities?

2 Answers available

What is your surveillance approach for outpatient monitoring of ICI myocarditis?

(i.e. frequency of serial BNP, troponin, cMRI)

2 Answers available

What is your approach to treatment of infection-triggered HLH that does not respond to treatment of the underlying infection?

2 Answers available

In the setting of secondary HLH associated with initial diagnosis of lymphoma, would you adjust steroid dose and type to account for differences in HLH and lymphoma treatment protocols?

1 Answer available

Given recent studies investigating ICI myocarditis biomarkers such as Temra CD8+ cells, is there now a growing selection of clinical biomarkers, besides BNP and troponin, being measured routinely in ICI myocarditis cases?

2 Answers available

When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?

2 Answers available

What are the best labs to trend improvement in HLH?

1 Answer available

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

6 Answers available

Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?

1 Answer available

Are there known biomarkers predictive of IRAEs?

3 Answers available

How do you discern whether elevated liver enzymes are from immunotherapy versus chemotherapy when a patient is on combination chemo/immunotherapy?

2 Answers available

Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?

Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?

2 Answers available

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

4 Answers available

Can you continue checkpoint inhibitor therapy in the setting of severe cutaneous irAE while concurrently treating the cutaneous reaction?

2 Answers available

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

2 Answers available

Papers discussed in this category

Journal for immunotherapy of cancer, 2017-11-21

Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group.

J Immunother Cancer, 2021 Feb

Success and failure of additional immune modulators in steroid-refractory/resistant pneumonitis related to immune checkpoint blockade.

J Natl Compr Canc Netw,

NCCN Guidelines Insights: Management of Immunotherapy-Related Toxicities, Version 1.2020.

Ann Oncol,

Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

J Immunother Cancer,

Steroid-refractory PD-(L)1 pneumonitis: incidence, clinical features, treatment, and outcomes.

J Immunother Cancer,

Real-world insights on preferred treatments for steroid-refractory immune checkpoint inhibitor-induced pneumonitis.

J Clin Oncol, 2021 Dec 20

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.

J Natl Compr Canc Netw,

Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology.

Eur J Cancer, 2021 Sep 15

Interleukin-6 blockade for prophylaxis and management of immune-related adverse events in cancer immunotherapy.

Thorac Cancer, 2020 Feb 11

The role of IL-6 in immunotherapy of non-small cell lung cancer (NSCLC) with immune-related adverse events (irAEs).

J Immunother Cancer,

Rechallenge patients with immune checkpoint inhibitors following severe immune-related adverse events: review of the literature and suggested prophylactic strategy.

Future Sci OA, 2020 Aug 03

A retrospective analysis of eosinophilia as a predictive marker of response and toxicity to cancer immunotherapy.

Cancer Treat Res Commun, 2022 Jul 01

Absolute eosinophil count predicts clinical outcomes and toxicity in non-small cell lung cancer patients treated with immunotherapy.

Trends Immunol, 2021 Mar 10

Predicting and Preventing Immune Checkpoint Inhibitor Toxicity: Targeting Cytokines.

Gastroenterology, 1993-06

Hepatoprotective properties of ursodeoxycholic acid.

Gastroenterology, 1991 Jul

Evidence for a direct hepatoprotective action of ursodeoxycholic acid in primary human hepatocytes.

Z Naturforsch C J Biosci, 2002 Mar-Apr

Prophylactic effect of aqueous propolis extract against acute experimental hepatotoxicity in vivo.

Immunopharmacol Immunotoxicol, 2003 Nov

Hepatoprotective effect of baicalin, a major flavone from Scutellaria radix, on acetaminophen-induced liver injury in mice.

Exp Toxicol Pathol, 2002 Feb

Acetaminophen hepatotoxicity and mechanisms of its protection by N-acetylcysteine: a study of Hep3B cells.

Biochem Biophys Res Commun, 1999 Sep 24

Ursodeoxycholic acid protects hepatocytes against oxidative injury via induction of antioxidants.

Ital J Gastroenterol Hepatol, 1998 Dec

Amantadine hydrochloride decreases serum ALT activity without effects on serum HCV-RNA in chronic hepatitis C patients.

Chem Biol Interact, 2001 Dec 21

Vitamin E succinate protects hepatocytes against the toxic effect of reactive oxygen species generated at mitochondrial complexes I and III by alkylating agents.

Eur Heart J, 2022 Nov 01

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS).

JACC CardioOncol, 2022 Dec 20

Immune Checkpoint Inhibitor Myocarditis Treatment Strategies and Future Directions.

Pediatric blood & cancer, 2011-01

Rate of decline of ferritin in patients with hemophagocytic lymphohistiocytosis as a prognostic variable for mortality.

Ther Adv Musculoskelet Dis, 2020 Nov 24

Efficacy of high-dose anakinra in refractory macrophage activation syndrome in adult-onset Still's disease: when dosage matters in overcoming secondary therapy resistance.

Eur Heart J, 2022 Jan 31

Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement.

J Am Heart Assoc, 2020 Jan 21

Immune Checkpoint Inhibitor Myocarditis: Pathophysiological Characteristics, Diagnosis, and Treatment.

Circulation, 2020 Jun 15

Major Adverse Cardiovascular Events and the Timing and Dose of Corticosteroids in Immune Checkpoint Inhibitor-Associated Myocarditis.

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