Photo Credit: Marcin Klapczynski
The following is a summary of “Antibody-Drug Conjugates: The Toxicities and Adverse Effects That Emergency Physicians Must Know,” published in the December 2024 issue of Emeregency Medicine by Markides et al.
Antibody-drug conjugates are innovative cancer treatments, gaining wider use as the variety of drugs and the number of individuals benefiting from them continue to grow.
Researchers conducted a retrospective study to review the toxicities and complications of FDA-approved antibody-drug conjugates for cancer, focusing on the emergency presentation and management.
They investigated the emergency management and complications associated with antibody-drug conjugates. The analysis covered common side effects such as diarrhea, nausea, vomiting, rash, peripheral neuropathy, and cytopenia, typically managed using standard-of-care approaches. Additionally, the specific adverse events tied to individual antibody-drug conjugates, focused on the clinical features and appropriate interventions.
The results showed trastuzumab deruxtecan and mirvetuximab soravtansine were associated with Interstitial Lung Disease, which can mimic pneumonia and potentially lead to respiratory failure or death. Emergency management involved oxygenation, ventilatory support, and corticosteroids. Inotuzumab ozogamicin and gemtuzumab ozogamicin were linked to Sinusoidal Obstruction Syndrome, presenting with weight gain, fluid overload, and jaundice. Abnormal liver function tests in recently treated individuals were advised to be cautiously interpreted. Rare cardiac effects included reduced cardiac contractility with trastuzumab emtansine and trastuzumab deruxtecan, as well as heart rate-corrected QT interval prolongation with trastuzumab deruxtecan. Blurred vision and keratopathy were frequently observed with mirvetuximab soravtansine and tisotumab vedotin. Progressive Multifocal Leukoencephalopathy was reported with brentuximab vedotin and polatuzumab vedotin. Tumor Lysis Syndrome was seen with gemtuzumab ozogamicin, polatuzumab vedotin, and brentuximab vedotin. Hyperglycemia and Diabetic Ketoacidosis occurred with enfortumab vedotin and brentuximab vedotin. Tisotumab vedotin and trastuzumab emtansine were linked to bleeding events, ranging from minor cases to severe intracranial hemorrhage. Anaphylactoid reactions, most common during or shortly after infusion, were also noted to be delayed by up to 24 hours.
Investigators concluded that the real-world incidence of rare complications, and the frequency of emergency presentations were associated with antibody-drug conjugates.
Source: annemergmed.com/article/S0196-0644(24)01142-9/fulltext
