New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management

Table 1 Different classes of new cancer drugs, frequently used agents, and main toxicities

Agent	Target	Indications	Toxicities
Monoclonal antibodies
Rituximab Ofatumumab Obinutuzumab	CD20	B-cell lymphomas and leukemias	CRS Immunodeficiency
Trastuzumab	HER2neu	Breast cancer	Cardiac disease
Cetuximab	EGFR	Colorectal cancer	Diarrhea Exanthema
Bevacizumab	VEGF	Colorectal cancer Breast cancer Renal cell cancer NSCLC	Hypertension GI bleeding or perforation Thromboembolism
Ramucirumab	VEGFR	Gastric cancer
Tyrosine kinase inhibitors
Imatinib Dasatinib	BCR-ABL	CML ALL	Pleural/pericardial effusions Pulmonary hypertension
Ponatinib	BCR-ABL	CML ALL	Thromboembolism
Erlotinib	EGFR	NSCLC Pancreatic cancer	Exanthema, diarrhea GI bleeding or perforation
Idelalisib	PI3K	B-cell lymphoma	Pneumonitis Colitis, hepatosis
Trametinib	MEK	Melanoma	Diarrhea, edema Decrease of LVEF
Aflibercept Axitinib	VEGF VEGFR	Colorectal cancer Renal cell cancer	Hypertension GI bleeding or perforation Thromboembolism PRES
Sorafenib Sunitinib Pazopanib	Multiple kinases	Renal cell cancer GIST Soft tissue sarcoma	Decrease of LVEF Hypertension
Bispecific antibodies (BAB)
Blinatumomab	CD3/CD19	ALL B-cell lymphomas	CRS Neurotoxicity (e.g., convulsions) Liver toxicity (transaminitis)
Checkpoint inhibitors
Ipilimumab	CTLA-4	Melanoma	IRAEs: Diarrhea, colitis Hypophysitis Immunhepatitis Polyarthritis
Nivolumab Pembrolizumab	PD-1	Melanoma NSCLC RCC Hodgkin’s lymphoma
Cellular treatments
CAR T cells	CD19	ALL B-cell lymphomas	CRS Neurotoxicity (e.g., convulsions, encephalopathy, or ischemia)

CRS cytokine-release syndrome, VEGF vascular endothelial growth factor receptor, VEGFR vascular endothelial growth factor receptor, HER human epidermal growth factor receptor, GI gastrointestinal, NSCLC non-small cell lung cancer, RCC renal cell cancer, LVEF left ventricular ejection fraction, CML chronic myeloid leukemia, ALL acute lymphoblastic leukemia, EGFR epidermal growth factor receptor, PI3K phosphoinositol-3 kinase, MEK MAP (mitogen-activated protein) kinase/ERK (extracellular signal-regulated kinase) kinase, PRES posterior reversible encephalopathy syndrome, GIST gastrointestinal stromal tumors, CTLA-4 cytotoxic T-lymphocyte-associated protein 4, PD-1 programmed death receptor 1, IRAEs immune-related adverse events, CAR chimeric antigen receptor

ISSN: 1364-8535