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Management of adverse events related to new cancer immunotherapy (immune checkpoint inhibitors)

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Important therapeutic advances have been made in the field of cancer immunotherapy in recent years. In particular, immune checkpoint inhibitors (ICIs) have revolutionised the treatment landscape of advanced cancer over the past 5 years, with 15–20% of patients achieving long term disease control beyond 5 years.1 ICIs are monoclonal antibodies which block cell surface molecules involved in the regulation of T cell activation, including cytotoxic T lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) and its ligand (PD-L1). In normal homoeostasis, these inhibitory molecules are involved in preventing excessive inflammation and autoimmunity.2 However, in the tumour microenvironment, these molecules are overexpressed and promote immune tolerance rather than tumour destruction.3 Blockade of these molecules can restore the appropriate anti-tumour response and potentially improve patient survival (Box 1). Other inhibitory and activating molecules are also involved in balancing T cell regulation, some of which are undergoing further research as therapeutic targets.24

ICIs with Pharmaceutical Benefits Scheme funding for use in Australia currently include ipilimumab (an anti-CTLA-4 antibody), nivolumab and pembrolizumab…