Journal of Oncology Research and Treatment
Open Access

For the treatment of lung cancer, Immune Checkpoint Inhibitor (ICI) therapy is now widely used in clinical trials. Although autoimmune disease and other comorbidities were initially excluded from clinical trials, emerging real-world evidence suggests that these promising treatments can also be safely administered to people with inactive low-risk autoimmune diseases like rheumatoid arthritis or psoriasis, mild to moderate renal and hepatic dysfunction, and certain chronic viral infections exacerbations of the underlying autoimmune disease, higher risk of ICI-induced immune-related adverse events, and the possibility of reduced efficacy in patients on prolonged immunosuppression. Immune checkpoint inhibitors must be carefully evaluated on a case-by-case basis in higher-risk autoimmune disorders such myasthenia gravis or multiple sclerosis. The use of immune checkpoint inhibitors in patients who have had a solid organ transplant increases chances of organ rejection.

Patient selection, treatment and monitoring may be assisted by ongoing research into the prediction of ICI efficacy and toxicity. Immune Checkpoint Inhibitors (ICIs) are currently applied in clinical trials to treat lung cancer and a number of other cancers. Indeed, nearly 44% of patients with advanced cancer may be candidates for ICI-based therapy, according to statistics.

ICIs have advanced cancer treatment in some instances. Combination ICI causes extremely durable responses in the majority of patients with metastatic melanoma, a cancer that is highly resistant to conventional chemotherapy. ICI has affected the assessment of efficacy in a limited group of patients, because clinicians may need to distinguish between progression, hyper progression and pseudo progression. From the perspective of a clinician, the possibility of autoimmune toxicity distinguishes ICI from chemotherapy and molecularly targeted medicines. When ICI-induced immune cell activation reacts with normal tissues, this is referred to as Immune- Related Adverse Events (IRAEs).

The brain, pituitary, eyes, thyroid, lungs, heart, liver, pancreas, colon, kidneys, adrenal, skin, joints, and muscles are all affected by immune-related adverse effects. Despite the well-known start of conventional chemotherapy toxicities such alopecia, nausea/vomiting, and myeloid suppression; IRAEs can happen at any time during ICI treatment. They may not occur several months after the last ICI dose in certain occasions. The field of immune-oncology, including individual clinicians, has gained experience and knowledge in treating patient’s IRAE. Nearly 3% of patients in early clinical trials of anti– programmed death 1 and anti–PD1 ligand medications in lung cancer developed fatal autoimmune pneumonitis. 5 Lethal incidents are exceedingly rare now that medical oncologists and their colleagues immediately evaluate the possibility of this IRAE in patients with new clinical or radiological respiratory symptoms.

Similarly, ICI effects on complex physiologic pathways such as the hypothalamic-pituitary-adrenal axis have led to recommendations for routine monitoring of endocrine function and early consultation with relevant experts.

Multimodal remedies have occasionally revealed unexpected side effects. For instance, a study of the combination of atezolizumab also with epidermal growth factor receptor inhibitor osimertinib identified a lung toxicity rate of much more than 50%, given the fact that each medicine caused pneumonitis with less than 5% of cases. Certain combinations, from the other hand, which have been expected to cause toxic effect, have been surprisingly well tolerated. In a phase III clinical trial, consolidating durvalumab for up to a year following chemo radiation for locally advanced non–small cell lung cancer resulted in only 3% of patients having high-grade pneumonitis, which used to be equal to flow rate with chemo radiation alone. Regardless of the fact that ICI therapy has created new side effects, it certainly provides fewer risks than other treatments in other areas. Alopecia, nausea/vomiting, and myelosuppression leading to cytopenias are by far the most common symptoms of cytotoxic chemotherapy. With ICI, these outcomes are extremely rare.