Targeted Immunotherapy in Urological Malignancies | Chapter 14 | Highlights on Medicine and Medical Research Vol. 13

 The treatment of urological cancers has been transformed by targeted immunotherapy. The method attempts to mimic the immune system's natural ability to eliminate cancer cells. This can be accomplished by the use of non-specific treatments like recombinant Bacillus Calmette-Guerin (BCG) or particular agents such immune checkpoint inhibitors (ICI) and anti-tumor vaccines. The use of BCG to prevent tumour recurrence and progression in non-muscle invasive bladder cancer has been a huge success (NMIBC). Immune checkpoint inhibitors have recently been utilised to degrade muscle. invasive (MIBC) to non-invasive (NMIBC) or even cure in clinical trials. In advanced renal cell carcinoma (RCC), castration-resistant prostate cancer (CRPC), and refractory germ cell tumour of the testis, the ICI has demonstrated a good response. Pembrolizumab, atezolizumab, and ipilimumab were found to be more effective than sunitinib, a tyrosine kinase inhibitor, which is now the standard of therapy for advanced RCC. The US Federal Drug Administration Agency has approved Sipuleucel-T, an autologous prostatic acid phosphatase dendritic cell loaded vaccination, for CRPC. Immunotherapy comes with controllable side effects such infusion responses and immune-related adverse events. invasive (MIBC) to NMIBC or even achieved cure at the level of clinical trials. The ICI has shown a positive response in advanced renal cell carcinoma (RCC), castration-resistant prostate cancer (CRPC), refractory germ cell tumour of the testis. The ICI such as pembrolizumab, atezolizumab and ipilimumab achieved better response than sunitinib, a tyrosine kinase inhibitor; which is the standard of care in advanced RCC. Sipuleucel-T, an autologous prostatic acid phosphatase dendritic cell loaded vaccine, has been approved by US Federal Drug Administration Agency for CRPC. Immunotherapy is associated with manageable toxicity such as infusion reactions and immune-related adverse event which respond to the use of corticosteroids with or without cessation of the therapy

Author (S) Details

Dr. Abubakar Sadiq Muhammad
Urology Unit, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria.

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A Comprehensive Review on Immune Checkpoint Inhibitor-induced Colitis | Chapter 5 | Highlights on Medicine and Medical Research Vol. 7

 Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target anti-cancer immune response down-regulators such as cytotoxic T-lymphocyte antigen-4, programmed cell death protein-1, and its receptor programmed death-ligand 1. Checkpoint inhibitors are known to cause IMC, which is one of the most common side effects. The immune system plays a crucial role in detecting and removing malignancies.

ICIs have also revolutionised the treatment of a variety of malignancies. However, there have been a number of immune-related side effects reported, the most of which arise when the immune system becomes less controlled and affects numerous organs, including the gastrointestinal tract, resulting in diarrhoea and colitis. Depending on the kind of ICI and if it is used in combination, the risk of immune-mediated colitis (IMC) ranges from 1% to 25%. IMC and inflammatory bowel disease have a lot of similarities endoscopically and histologically, however IMC usually has greater neutrophilic inflammation without persistent inflammation. While on immunotherapy, corticosteroids are advised for grade 2 or greater severe colitis. Between one-third and two-thirds of patients who are steroid refractory benefit from infliximab. In steroid and infliximab-resistant conditions, vedolizumab has recently been demonstrated to be efficacious. The decision in grade 3 colitis is arguable if immunotherapy is permanently halted in grade 4 colitis.

Author(s) Details

Aniruddh Som
Department of Internal Medicine, Medstar Washington Hospital Center, Washington, DC 20010, United States.

Rohan Mandaliya
Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States.

Dana Alsaadi
Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States.

Maham Farshidpour
Department of Internal Medicine, MedStar Union Memorial Hospital and Good Samaritan Hospital, Baltimore, MD 21218, United States.

Aline Charabaty
Department of Gastroenterology, Sibley Memorial Hospital, Washington, DC 20007, United States.

Nidhi Malhotra
Department of Gastroenterology, MedStar Washington Hospital Center, Washington, DC 20010, United States.

Mark C. Mattar
Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States.

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