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Immune checkpoint inhibitors (ICI) represent a breakthrough in cancer therapy. They are effective in various tumor entities and can be used in more and more treatment settings. This leads to an increase in the number and complexity of cases with immune-related adverse events (irAE). The most common irAE are cutaneous, gastrointestinal and endocrine side effects, whereas less common irAE include pneumonitis, nephritis, myocarditis or neurological reactions. IrAE can usually be successfully treated, mainly with corticosteroids or other immunosuppressants, but they can also result in long-term sequelae or death. The optimal management of patients with steroid-refractory or steroid-dependent side effects still remains unclear. Broad awareness of these irAE across specialties is therefore of crucial importance to ensure early diagnosis and to improve irAE management., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In the context of supportive therapy, possible complaints which may be caused by the cancer itself, by the antitumoral therapy or by psychosocial concerns are considered. Due to the introduction of new anticancer drugs in dermato-oncology, clinicians are confronted with a novel spectrum of adverse events. There are a number of inflammatory, immune-mediated side effects caused by immunotherapies, which can affect virtually any organ. Targeted therapies also have specific side effects. Basically, the management of adverse events depends on their severity. Besides treatment breaks and dosage modifications, immunotherapy-related adverse events are treated with systemic immunosuppressants. Supportive symptomatic therapy is offered. The additional consideration of psychosocial problems can improve quality of life of cancer patients.

The immune oncological treatment approach uses immune checkpoint inhibitors to prevent tumor cells from shutting down the immune system, and thus from escaping immune response. Following the clinical success of immune checkpoint inhibitors, the number of approved immune oncological therapies continues to increase. Response rates and overall survival with anti-PD-1/PD-L1 and CTLA-4 blockade could be further improved by combining both treatment approaches. However, checkpoint inhibition is associated with a unique spectrum of side effects termed immune-related adverse events. These typically occur 3 to 6 months after treatment start and resolve with adequate management procedures if detected early on. Therefore, profound patient education, sensitizing and monitoring are mandatory. We describe in this article selected frequent and rare adverse events that are clinically relevant. Furthermore, using case reports, interdisciplinary experts share their practice-based experience in the management of frequent pneumonic, endocrine, and gastro-intestinal immune-related adverse events., Competing Interests: N. Reinmuth: erhielt Honoraria für Vortragstätigkeiten und Beratungen von Roche, Lilly, Novartis, MSD, BMS, Boehringer-Ingelheim, Astra-Zeneca, Takeda, Celgene und Pfizer.M. Bitzer: Advisory Board für die Firmen Bayer Healthcare, Bristol-Myers Squibb, EISAI, IPSEN und Lilly.B. Deschler-Baier erhielt Vortragshonorare von BMS.J.R. Fischer erhielt Honorare für Beratertätigkeiten und Vorträge von AstraZeneca, Boehringer Ingelheim, Celgene und Hoffmann-La Roche.J. Kuon erhielt Honorare für Beratertätigkeiten und Vorträge von Astrazeneca, Chugai und Roche.J. Leipe erhielt Honorare für Beratertätigkeiten und Vorträge von Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB; Scientific Support: Novartis, Pfizer.J. Rawluk erhielt Honorare für Beratertätigkeiten und Vorträge von AstraZeneca, Takeda, MSD, BMS, Boehringer Ingelheim und Roche.C. Schulz: Honorare aus Referententätigkeiten: AstraZeneca, Boehringer, Celgene, Lilly, MSD, Novartis, Roche. Honorare aus Beratertätigkeiten: AstraZeneca, AbbVie, BMS, Boehringer, Lilly, MSD, Novartis, Roche. Teilnahme an Klinischen Studien: AstraZeneca, BMS, Boehringer, Lilly, MSD, Novartis, Roche, Pfizer.M. Schultheiß: Beratertätigkeit für Bayer Healthcare und Bristel Myers Squibb.C. Heußel hat Verbindungen mit verschiedenen Firmen, die Immunonkologika herstellen.Die Erstellung dieses Artikels wurde von AstraZeneca GmbH unterstützt., (© Georg Thieme Verlag KG Stuttgart · New York.)

Cancer is one of the leading causes of death worldwide. New targeted and individualized therapies and drugs provide a survival benefit for an increasing number of patients, but can also cause severe side effects. An increasing number of oncology patients are admitted to intensive care units (ICU) because of cancer-related complications or treatment-associated side effects. Postoperative care, respiratory distress and sepsis are the leading causes for admission. Tumor mass syndromes and tumor lysis may require urgent treatment. Traditional anticancer chemotherapy is associated with infections and immunosuppression. Newer agents are generally well-tolerated and side effects are mild or moderate, but overwhelming inflammation and autoimmunity can also occur. Cellular treatment, such as with chimeric antigen receptor modified T‑cells, monoclonal and bispecific antibodies targeting immune effectors and tumor cells are associated with cytokine release syndrome (CRS) with hypotension, skin reactions and fever. It is related to excessively high levels of inflammatory cytokines. Immune checkpoint inhibitors can lead to immune-related adverse events (IRAEs), such as colitis and endocrine disorders. Noninfectious respiratory complications, such as pneumonitis can also occur. Recent studies revealed that short-term and medium-term survival of cancer patients is better than previously expected. In this review article we summarize diagnostic and treatment strategies for common life-threatening complications and emergencies requiring ICU admission. Furthermore, strategies for rational admission policies are presented.

Psychotropics are highly effective medications that, however, have adverse drug reactions attached to them. They are indispensable for many patients. How to cope with side effects - watchful waiting, dose reduction, change of medication, addition of an "antidote" and behavioural modifications - depends on their nature, severity and finally the patients wish. This review is meant to aid clinician's and patient's decisions in case of the occurrence of compromising, frequent adverse drug reactions., Competing Interests: Interessenkonflikte: Anna Grunze gibt an, dass keine Interessenkonflikte bestehen.Rajnish Mago erhielt in den letzten 3 Jahren Forschungsunterstützung oder Honorare für Beratung oder Vorträge von nachfolgenden Institutionen und Firmen, die z.T. auch in diesem Artikel erwähnte Medikamente vertreiben: Alkermes, Inc.; Allergan, Plc.; Genomind, Inc.; Lundbeck, Otsuka America Pharmaceutical, Inc. und Takeda Pharmaceuticals U.S.A., Inc.Heinz Grunze erhielt in den letzten 3 Jahren Forschungsunterstützung oder Honorare für Beratung oder Vorträge von nachfolgenden Institutionen und Firmen, die z.T. auch in diesem Artikel erwähnte Medikamente vertreiben: Gedeon-Richter, Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Servier., (© Georg Thieme Verlag KG Stuttgart · New York.)

The effect of medication is always a balance between their beneficial effects and any adverse reactions they might elicit. The main risk for adverse drug events {ADEs) is polypharmacy, which is the simultaneous use of multiple drugs.This often applies to older patients, who suffer from multiple diseases and therefore take multiple medications. Thus, itis not surprising, that ADEs are frequention older patients and account up to 16% of emergency visits. It is still under discussion, whether age is an independent risk factor for ADEs. However, there are some age-related changes in the pharmacokinetic and pharmacodynamics properties of many drugs, which may influence the highly fragile balance between benefit and harm in older patients. Though there are multiple risk factors for and causes of ADEs, it could be shown that a lot of ADEs are preventable and even predictable: Budnitz eta/. showed that almost two thirds of emergency hospitalisations occur due to four medication classes: warfarin, oral antiplatelet agents, insulin and oral hypoglycaemic agents. Nevertheless, only 40-60% ofA DEs are recognized in the emergency department. This might be explained by the broad clinical symptoms, ranging from bleeding due to anticoagulants to the more nonspecific symptom of weakness due to hyponatraemia secondary to thiazide diuretics. Detecting and avoiding ADEs could be aided by using lists such as Beers criteria or STOPP/FART which list medications which are potentially inappropriate for older patients.