TY - CHAP M1 - Book, Section TI - Immunological Therapies in Oncology A1 - Rajendram, Prabalini A1 - Gutierrez, Cristina A1 - Pastores, Stephen M. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSCancer immunotherapy utilizing T cells to eliminate tumors has become the fifth pillar of cancer treatment alongside surgery, radiotherapy, chemotherapy, and targeted therapy.Two major immunotherapeutic approaches to treat cancer include immune checkpoint blockade and adoptive T cell therapy with tumor-infiltrating lymphocytes and chimeric antigen receptors (CARs).Immune checkpoint inhibitors (ICIs) can cause overwhelming inflammation and tissue damage, resulting in autoimmune-like toxicities known as immune-related adverse events (irAEs).The most studied and targeted immune checkpoint receptors are programmed death-1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen-4 (CTLA-4).The frequency and severity of irAEs are higher with anti-CTLA-4 alone and in combination therapy with anti-PD-1. Additionally, the most serious irAEs are pulmonary, neurologic, and cardiovascular toxicities.The use of systemic corticosteroids and discontinuation of ICI is the mainstay of therapy for higher grade irAEs.Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the most common toxicities associated with CAR-T therapy.Anticytokine therapy (eg, tocilizumab) and corticosteroids, in addition to supportive measures, are the mainstays of treatment of CRS.Management of ICANS includes the use of corticosteroids, and control of seizures and cerebral edema in severe cases. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/09/08 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201808429 ER -