Perioperative Implications of Biologics and Immunotherapy

Adv Anesth. 2024 Dec;42(1):97-113. doi: 10.1016/j.aan.2024.07.008.

Abstract

Immune check inhibitors (ICIs) are a class of biologic therapy used for cancer treatment that enhances T-cell recognition of cancer cells. Toxicities from ICIs are described as immune-related adverse events (irAEs) with Grade 1 to 2 irAEs representing mild-to-moderate toxicity and Grade 3 to 4 irAEs representing severe to life-threatening toxicity. The long half-life of ICIs contributes to the extended and unpredictable nature of irAEs. ICI therapy is typically stopped for Grade 3 to 4 irAEs except for endocrinopathies if clinically optimized. Toxicities can involve any organ system; therefore, a thorough preoperative assessment is imperative to ensure appropriate clinical management.

Keywords: Biologics; Immune checkpoint inhibitor; Immune-related adverse events (irAEs); Immunotherapy; Perioperative; Toxicity.

Publication types

  • Review

MeSH terms

  • Biological Products* / administration & dosage
  • Biological Products* / adverse effects
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Immunotherapy* / methods
  • Neoplasms / drug therapy
  • Perioperative Care / methods

Substances

  • Biological Products
  • Immune Checkpoint Inhibitors