Nov 9, 2026 · 1h 26m
Immune therapies can trigger delayed, life-threatening organ damage
#545: Immune Checkpoint Inhibitor Complications: Recognizing and Managing Immune-Related Adverse Events
As checkpoint inhibitors become routine cancer treatment, internists must recognize toxicities that can emerge long after therapy begins or ends and may involve several organs at once.
- 1Delayed immune toxicities can affect nearly any organ, making treatment history and persistent suspicion essential even after therapy ends.
- 2Severe colitis requires infection evaluation, prompt immunosuppression, prophylaxis, and careful decisions about tapering and immunotherapy rechallenge.
- 3Myositis, myocarditis, and myasthenia-like weakness can overlap as an oncologic emergency despite a normal ejection fraction.
Don't miss
The discussion of overlapping myositis, myocarditis, and myasthenia-like weakness shows why normal ejection fraction cannot rule out a dangerous emergency.
The brief
Kerry Reynolds joins the hosts to explain why checkpoint-inhibitor complications now belong in every internist’s differential, including events that appear months or more than a year after treatment.
A severe diarrhea case shows the diagnostic and treatment sequence: exclude infection and alternatives, grade the colitis, start steroids when necessary, and weigh infliximab against vedolizumab.
Fatigue, nausea, diarrhea, and hyponatremia reveal central adrenal insufficiency from hypophysitis, underscoring why morning cortisol belongs in a broad evaluation rather than a narrow endocrine workup.
The standout case combines myositis, myocarditis, and myasthenia-like weakness after pembrolizumab; CK, troponin, ECG, cardiac imaging, and respiratory monitoring become urgent even with preserved ejection fraction.
Across the cases, Reynolds frames rechallenge after severe toxicity as possible but uncommon, while emphasizing multidisciplinary care, prophylaxis, and the absence of reliable predictive biomarkers.
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