Background Various types of immunotherapy (i.e. immune checkpoint inhibitors [ICIs], chimeric antigen receptor [CAR] T-cells and bispecific T-cell engagers [BiTEs]) and antibody drug conjugates (ADCs) have been used increasingly to treat solid cancers, lymphomas and leukaemias. Patients with serious complications of these therapies can be presented to physicians of different specialties. In this narrative review we discuss potentially fatal complications of new systemic anticancer therapies and some practical considerations for their diagnosis and initial treatment. Results Clinical presentation of toxicities of new anticancer therapies may be unpredictable and nonspecific. They can mimic other more common medical conditions such as infection or stroke. If not recognized and properly treated these toxicities can progress rapidly into life-threatening conditions. ICIs can cause immune-related inflammatory disorders of various organ systems (e.g. pneumonitis or colitis), and a cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) may develop after treatment with CAR T-cells or BiTEs. The cornerstones of management of these hyper-inflammatory disorders are supportive care and systemic immunosuppressive therapy. The latter should start as soon as symptoms are mild-moderate. Similarly, some severe toxicities of ADCs also require immunosuppressive therapy. A multidisciplinary team including an oncologist/haematologist and a corresponding organ-site specialist (e.g. gastroenterologist in the case of colitis) should be involved in the diagnosis and treatment of these toxicities. Conclusions Health professionals should be aware of potential serious complications of new systemic anticancer therapies. Early diagnosis and treatment with adequate supportive care and immunosuppressive therapy are crucial for the optimal outcome of patients with these complications.

中文翻译：

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新的全身抗癌疗法的潜在致命并发症：初始管理中的亮点和陷阱

背景 各种类型的免疫疗法（即免疫检查点抑制剂 [ICIs]、嵌合抗原受体 [CAR] T 细胞和双特异性 T 细胞接合剂 [BiTE]）和抗体药物偶联物 (ADC) 已越来越多地用于治疗实体癌、淋巴瘤和白血病。患有这些疗法严重并发症的患者可以就诊于不同专业的医生。在这篇叙述性综述中，我们讨论了新的全身抗癌疗法的潜在致命并发症以及其诊断和初始治疗的一些实际考虑因素。结果 新抗癌疗法的毒性临床表现可能是不可预测且非特异性的。它们可以模仿其他更常见的医疗状况，例如感染或中风。如果不认识并适当治疗，这些毒性可能会迅速发展为危及生命的状况。 ICI 可引起多种器官系统的免疫相关炎症性疾病（例如肺炎或结肠炎），并且在使用 CAR T 细胞或 BiTE 治疗后可能会出现细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS）。治疗这些高炎症性疾病的基石是支持治疗和全身免疫抑制治疗。后者应在症状为轻度至中度时立即开始。同样，ADC的一些严重毒性也需要免疫抑制治疗。包括肿瘤学家/血液学家和相应器官部位专家（例如结肠炎的胃肠病学家）在内的多学科团队应参与这些毒性的诊断和治疗。结论 卫生专业人员应意识到新的全身抗癌疗法潜在的严重并发症。早期诊断和治疗以及充分的支持护理和免疫抑制治疗对于患有这些并发症的患者获得最佳结果至关重要。