The underlying precise pathophysiology of these immune\related events and differences are yet to be elucidated, but it is believed the host genetics and microbiota perform important roles.5, 6, 7 In a recent article by Yang em et al /em .8 entitled Management of Adverse Events in Cancer Individuals Treated With PD\1/PD\L1 Blockade: Focus on Asian Populations, the authors elaborately examined the different types of immune\related adverse events and their potential related treatments by mainly focusing on Asian individuals. Food and Drug Administration, namely nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab and ipilimumab. They have shown efficacies in several cancers, including melanoma (ipilimumab, nivolumab, pembrolizumab), non\small cell lung malignancy (nivolumab, pembrolizumab, atezolizumab), urothelial malignancy (nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab), classic Hodgkin’s lymphoma (nivolumab, pembrolizumab) and more. Suppression of the CTLA4 and PD1 pathways allows tumor\specific T cells to increase and promotes antitumor activity. The main dilemma is definitely that these immune proteins also exist in noncancerous cells such as endothelium, intestines and heart with many as yet undiscovered.3 Although we can stimulate the expansion of T cells, we are still not able to fully control the extent of this expansion, thereby leading to undesirable adverse events which can affect any bodily organ. These adverse events can range from moderate to fatal, mostly depending on the organ(s) involved and the severity of the reactions. They can occur at any time after treatment initiation but usually appear in the first few weeks to months after treatment, or treatment discontinuation. To complicate points, the adverse events of those treated with anti\CTLA4 therapy differs from those treated with anti\PD\1.4 In contrast, those of anti\CTLA4 tend to be more severe. The underlying precise pathophysiology of these immune\related events and differences are yet to be elucidated, but it is usually believed that this host genetics and microbiota play important functions.5, 6, 7 In a recent article by Yang em et al /em .8 entitled Management of Adverse Events in Cancer Patients Treated With PD\1/PD\L1 Blockade: Focus on Asian Populations, the authors elaborately examined the different types of immune\related adverse events and their potential corresponding treatments by mainly focusing on Asian patients. They reported that the range of immune\related adverse events (irAEs) in Asian populations can range from 12% to 90% and that the type of irAEs experienced differs among different malignancies; possibly related to the sites of action or organs where T\cell aggregation have been occurred. The mainstay of irAEs treatments are TP808 the use of immunosuppressive brokers. Glucocorticoids are usually used as the first\collection for immunosuppressive agent and if not initially effective, additional brokers can be used. Based on the AEs gradings of the Common Terminology Criteria for Adverse Events (CTCAE) and the recommendations of the American Society of Clinical Oncology, patients found to have grade 1 irAEs can continue therapy, but under close monitoring. For grade 2 irAEs, therapy should be suspended, but can be continued if the symptoms or laboratory results regress to grade??1. For grade 3 irAEs, therapy should be suspended, high\dose corticosteroids should be initiated and if patients’ conditions do not ameliorate within 2C3?days, treatment with infliximab should be considered. For those with grade 4 irAEs, permanent discontinuation of the immune therapy is advised, except for endocrine abnormalities that have shown amelioration with hormone replacement therapy. Finding the optimal management of irAEs is usually difficult as they may impact a wide spectrum of body organs and tissues despite numerous efforts in immuno\oncology research to fight malignancy. Management efforts still rely on the clinical experience of the treating physicians, although collaboration via multidisciplinary team would be more effective, especially when dealing with rare but potentially life\threatening irAEs, such as myocarditis and pneumonitis, as until recently there have been no prospective clinical trials defining the best irAEs treatment methods.9 One possible alternative would be simulating these conditions using animal models capable of mimicking the human immune microenvironment, but this has been very challenging to date and is still at the investigation stage10 Unlike in other forms of TP808 therapies in PCDH8 which disease progression can result when treatment is halted due to, or for treating the related AEs, the use of immunosuppressive agents in treating irAEs did not show any differences in antitumor efficacy between those requiring and not requiring them, although precautions for opportunistic infections should be carefully assessed. The security implications to restart immunotherapy after regression of the irAEs and the optimal time to restart them, or whether TP808 a watch and wait strategy would be relevant have not been prospectively investigated but retrospective analyses have suggested that irAEs associated with one class of agent may not recur during subsequent treatment with another agent.6, 11 In summary, immunotherapy can be viewed as a double\edged sword. With regard to tumor.
