Annals On Call Podcast · American College of Physicians

Checkpoint Inhibitors: What Generalists Need to Know

April 15, 2024·23 min·2 clips

Dr. Bob Centor reveals that immune-related adverse events can occur anywhere from two days to two years after treatment.

This episode explains immune-related adverse events from checkpoint inhibitor cancer therapies for generalist physicians. Host Dr. Bob Centor is joined by Dr. Brian Westbrook, a chief medical resident entering oncology, and Dr. R.J. Blackburn, who leads an inpatient oncology service. They analyze a clinical review article from the *Annals of Internal Medicine* on this topic. The discussion centers on the timing, diagnosis, and management of these inflammatory side effects. Dr. Blackburn notes the wide onset window for immune-related adverse events, ranging from two days to two years after treatment initiation. He states the majority of these events, however, occur between two weeks and two months. The conversation covers common organ systems affected, including the endocrine system, skin, and gastrointestinal tract. Specific conditions like colitis, hepatitis, and pneumonitis are highlighted as critical diagnoses. The panel emphasizes that these adverse events result from the drug's intended mechanism of unleashing the immune system. A key insight is that generalists must consider checkpoint inhibitor therapy in any patient presenting with new inflammatory symptoms, even long after treatment. The hosts stress that stopping the immunotherapy and promptly initiating corticosteroids is the cornerstone of management for severe events. They clarify that managing these complications often does not require an oncologist's immediate involvement, empowering internists and hospitalists. Dr. Blackburn explains the importance of ruling out infection or disease progression before attributing symptoms to an immune-related cause. The tone is strictly educational and clinical, structured as a formal journal club discussion. The style is conversational yet precise, with the host guiding experts through a systematic review of the article's recommendations. This episode is essential for internists, family physicians, and hospitalists who co-manage cancer patients receiving immunotherapy. Listeners seeking broad patient stories or non-clinical perspectives might find the content too specialized.

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from Annals On Call Podcast