Melanoma pp 577-589 | Cite as

Immune-Related Adverse Toxicities and Clinical Management

  • Michael Constantin Kirchberger
  • Lucie HeinzerlingEmail author


Checkpoint inhibitors are effective in various cancer entities. However, especially in the combination of anti-CTLA-4 antibodies with anti-PD-1 antibodies they induce considerable toxicity with around 56% grade 3/4 adverse events. These side effects may involve skin, the gastrointestinal tract, liver, the endocrine system, and other organ systems. In combination therapy in about a third of patients more than one organ system is affected. Since life-threatening and fatal immune-related adverse events (irAE) have been reported, adequate diagnosis and management is essential. Besides well-known irAE, checkpoint inhibitors can induce a plethora of side effects including neurologic and cardiotoxic events. Prompt diagnosis and management can reduce morbidity and mortality due to these autoimmune side effects.

This chapter gives an overview on how to approach side effects diagnostically and therapeutically in patients under checkpoint inhibitor therapy. It includes information on patient education, important differentials, and algorithms for therapy.


Checkpoint inhibitors Autoimmunity Serious adverse events Toxicity Side effect management Ipilimumab Nivolumab Pembrolizumab 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michael Constantin Kirchberger
    • 1
  • Lucie Heinzerling
    • 1
    Email author
  1. 1.Department of DermatologyUniversity Hospital ErlangenErlangenGermany

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