Management of Life Threatening irAE
Aaron Tan, National Cancer Centre Singapore

The introduction of immune checkpoint inhibitors (ICIs) and immunotherapy in recent years has added to the armamentarium of anti-cancer therapy. However, immune checkpoints also play a physiological role in maintaining immunological tolerance to self-antigens. Consequently, considering their mechanism of action, ICIs have a unique toxicity profile unlike that seen with conventional chemotherapeutic agents or targeted therapies, commonly referred to as immune-related events (irAEs). The management of irAEs commonly includes immunosuppression with corticosteroids as first-line treatment along with a temporary hold or permanent discontinuation of the ICI, depending on the grade of the adverse event. In refractory cases, other immunosuppressive therapy may be required, and management may also vary according to the organ system affected. As novel combinations of ICIs and other therapies, as well as other forms of immunotherapy are increasingly explored, an awareness and understanding of managing irAEs, including life threatening irAEs, is paramount.