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Autops. Case Rep ; 11: e2021261, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285410


Immune-mediated encephalitis as an adverse event due to checkpoint inhibitors is very rare. We describe herein the case of a 38-year-old woman with metastatic triple-negative breast cancer who developed seizures and somnolence twelve days after receiving the first dose of Atezolizumab. Work up ruled out all infectious etiologies, and the patient was eventually diagnosed with immune-mediated meningoencephalitis. Symptoms recovered with a high-dose of steroids, and she was found to have an excellent response on follow-up imaging, which raised the question of whether a relationship exists between the occurrence, and severity of the adverse event and the response to treatment. Only a few other cases of atezolizumab-related encephalitis have been published. Early recognition and treatment are crucial; the reason why we are describing this case along with a review of the literature and a review on all the neurological immune-related adverse events due to the different checkpoint inhibitors.

Humans , Female , Adult , Adenocarcinoma , Triple Negative Breast Neoplasms/pathology , Antineoplastic Agents, Immunological/adverse effects , Meningoencephalitis/pathology , Drug-Related Side Effects and Adverse Reactions , Immunotherapy/adverse effects , Neurologic Manifestations
Frontiers of Medicine ; (4): 783-804, 2021.
Article in English | WPRIM | ID: wpr-922520


The current standard of care in hematological malignancies has brought considerable clinical benefits to patients. However, important bottlenecks still limit optimal achievements following a current medical practice. The genetic complexity of the diseases and the heterogeneity of tumor clones cause difficulty in ensuring long-term efficacy of conventional treatments for most hematological disorders. Consequently, new treatment strategies are necessary to improve clinical outcomes. Chimeric antigen receptor T-cell (CAR T) immunotherapy opens a new path for targeted therapy of hematological malignancies. In this review, through a representative case study, we summarize the current experience of CAR T-cell therapy, the management of common side effects, the causative mechanisms of therapy resistance, and new strategies to improve the efficacy of CAR T-cell therapy.

Hematologic Neoplasms/therapy , Humans , Immunotherapy/adverse effects , Neoplasms , Receptors, Chimeric Antigen , T-Lymphocytes
Chinese Journal of Lung Cancer ; (12): 668-672, 2021.
Article in Chinese | WPRIM | ID: wpr-922239


Immune checkpoint inhibitors (ICIs) is a negative regulatory factor antibody, which activates T cells to play an anti-tumor effect in immunotherapy, and can also cause immune-related adverse responses, thereby inducing a series of immune related adverse events (irAEs). Among these irAEs, although the incidence of ICIs-related myocarditis is very low, the fatality rate is significantly higher than other adverse reactions, close to 50%. Clinicians should be vigilant when applying ICIs, but the pathogenesis of ICIs-related myocarditis is still unclear. This article combines the recent research results of ICIs to summarize the mechanism and clinical manifestations of ICIs-related myocarditis, so as to improve clinicians' understanding of the adverse reactions.

Biomedical Research/trends , Cardiotoxicity/physiopathology , Humans , Immune Checkpoint Inhibitors/therapeutic use , Immunotherapy/adverse effects , Myocarditis/physiopathology , Neoplasms/drug therapy
Frontiers of Medicine ; (4): 33-42, 2021.
Article in English | WPRIM | ID: wpr-880945


Immunotherapy has recently led to a paradigm shift in cancer therapy, in which immune checkpoint inhibitors (ICIs) are the most successful agents approved for multiple advanced malignancies. However, given the nature of the non-specific activation of effector T cells, ICIs are remarkably associated with a substantial risk of immune-related adverse events (irAEs) in almost all organs or systems. Up to 90% of patients who received ICIs combination therapy experienced irAEs, of which majority were low-grade toxicity. Cytotoxic lymphocyte antigen-4 and programmed cell death protein-1/programmed cell death ligand 1 inhibitors usually display distinct features of irAEs. In this review, the mechanisms of action of ICIs and how they may cause irAEs are described. Some unsolved challenges, however really engrossing issues, such as the association between irAEs and cancer treatment response, tumor response to irAEs therapy, and ICIs in challenging populations, are comprehensively summarized.

Antineoplastic Agents/adverse effects , Humans , Immune Checkpoint Inhibitors , Immunotherapy/adverse effects , Neoplasms/drug therapy
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 95-104, sept. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1128985


La relación entre inmunidad y cáncer es compleja. Las células tumorales desarrollan mecanismos de evasión a las respuestas del sistema inmunitario. Esta capacidad permite su supervivencia y crecimiento. La inmunoterapia ha transformado el tratamiento oncológico mejorando la respuesta inmunitaria contra la célula tumoral. Esta se basa en el bloqueo de los puntos de control inmunitario mediante anticuerpos monoclonales contra la molécula inhibidora CTLA-4 (antígeno 4 del linfocito T citotóxico [CTLA-4]) y la proteína 1 de muerte celular programada y su ligando (PD-1/PD-L1). Aunque los inhibidores de los puntos de control inmunitario (ICIs) son fármacos bien tolerados, tienen un perfil de efectos adversos conocido como eventos adversos inmunorrelacionados (EAI). Estos afectan varios sistemas, incluyendo las glándulas endocrinas. Los eventos adversos endocrinos más frecuentes son la disfunción tiroidea, la insuficiencia hipofisaria, la diabetes mellitus autoinmune y la insuficiencia suprarrenal primaria. El creciente conocimiento de estos efectos adversos endocrinos ha llevado a estrategias de tratamiento efectivo con el reemplazo hormonal correspondiente. El objetivo de esta revisión es reconocer la incidencia de estas nuevas endocrinopatías, la fisiopatología, su valoración clínica y el manejo terapéutico. (AU)

The relationship between immunity and cancer is complex. Tumor cells develop evasion mechanisms to the immune system responses. This ability allows their survival and progression. Immunotherapy has transformed cancer treatment by improving the immune response against tumor cells. This is achieved by blocking immune checkpoints with monoclonal antibodies against cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 and its ligand (PD-1 / PD-L1). Although the immune checkpoint inhibitors (ICIs) are well tolerated drugs, they have a profile of adverse effects known as immune-related adverse events (irAES). These involve diverse systems, including the endocrine glands. The most frequent endocrine immune-related adverse events are thyroid and pituitary dysfunction, autoimmune diabetes mellitus and primary adrenal insufficiency. The increasing knowledge of these irAES has led to effective treatment strategies with the corresponding hormonal replacement. The objective of this review is to recognize the incidence of these new endocrinopathies, the physiopathology, their clinical evaluation, and therapeutic management. (AU)

Humans , Endocrine System Diseases/chemically induced , Immunotherapy/adverse effects , Thyroid Diseases/diagnosis , Thyroid Diseases/chemically induced , Thyroid Diseases/pathology , Thyroid Diseases/therapy , Thyroxine/administration & dosage , Triiodothyronine/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/chemically induced , Adrenal Insufficiency/pathology , Adrenal Insufficiency/therapy , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 1/chemically induced , Diabetes Mellitus, Type 1/pathology , Diabetes Mellitus, Type 1/therapy , Endocrine System Diseases/diagnosis , Endocrine System Diseases/physiopathology , Endocrine System Diseases/therapy , Hypophysitis/diagnosis , Hypophysitis/chemically induced , Hypophysitis/pathology , Hypophysitis/therapy , Glucocorticoids/administration & dosage , Insulin/therapeutic use , Methimazole/therapeutic use , Mineralocorticoids/therapeutic use , Antibodies, Monoclonal/therapeutic use , Neoplasms/immunology
Article in Chinese | WPRIM | ID: wpr-878685


While immune checkpoint inhibitors(ICIs)are effective and promising treatments for a variety of malignancies,they also have safety concerns,especially the immune-related adverse events(irAEs).Unlike the side effects of traditional chemotherapy and targeted therapy,irAEs are adverse events caused by immune activation after ICIs treatment and thus may involve almost every system of the body.Therefore,biomarkers for predicting irAEs after ICIs treatment are urgently needed.Here we review the currently available predictive biomarkers of irAEs.

Biomarkers , Humans , Immune Checkpoint Inhibitors/adverse effects , Immunotherapy/adverse effects , Neoplasms/drug therapy
Chinese Medical Journal ; (24): 2595-2598, 2020.
Article in English | WPRIM | ID: wpr-877820


With the increasing use of immune checkpoint inhibitors (ICI) including anti-cytotoxic T lymphocyte associated antigen-4 (CTLA-4) and anti-programmed cell death-1 (PD-1) in cancers, ICI-induced type 1 diabetes has been reported throughout the world. In this review, we aim to summarize the characteristics of this disease and discuss the mechanism of it. As an immune-related adverse event, type 1 diabetes developed after the administration of anti-PD-1 or anti-PD-ligand 1 (PD-L1) in the combination with or without anti-CTLA-4. It usually presented with acute onset, and 62.1% of the reported cases had diabetic ketoacidosis. Only a third of them had positive autoantibodies associated with type 1 diabetes. Susceptible HLA genotypes might be associated. T-cell-stimulation by blocking of the interaction of PD-1 and PD-L1 in pancreatic β cells was the main mechanism involved in the pathology. Insulin was the only effective treatment of ICI-induced type 1 diabetes. In conclusions, ICI-induced type 1 diabetes is a potentially life-threating adverse event after the immunotherapy of cancers. Screening and early recognition is important. Further investigation of the mechanism may help to better understand the pathology of type 1 diabetes.

CTLA-4 Antigen , Diabetes Mellitus, Type 1/chemically induced , Humans , Immune Checkpoint Inhibitors , Immunologic Factors/therapeutic use , Immunotherapy/adverse effects , Neoplasms/drug therapy
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 146-148, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1099838


Los anticuerpos monoclonales que inhiben los puntos de control PD-1 y CTLA-4 se usan actualmente en el tratamiento del melanoma y cáncer metastásico de pulmón de células no pequeñas, entre otros. Se refiere el caso de una paciente con cáncer de pulmón en tratamiento con pembrolizumab. La paciente se presentó con edema facial y parálisis facial periférica. En el laboratorio se observó la hormona tirotrofina (TSH) elevada y se llegó al diagnóstico de hipotiroidismo por pembrolizumab. Inició tratamiento con levotiroxina con mejoría clínica. Se presenta este caso por el importante papel del dermatólogo en el manejo multidisciplinario del paciente oncológico. (AU)

Monoclonal antibodies that inhibit PD-1 and CTLA-4 control points are currently used in the treatment of melanoma and metastatic non-small cell lung cancer, among others. The case of a patient, with lung cancer being treated with Pembrolizumab. The patient was presented with facial edema and peripheral facial paralysis and in the laboratory the elevated hormone Tyrotrophin (TSH) was observed, the diagnosis of pembrolizumab hypothyroidism was reached. She started treatment with levothyroxine with clinical improvement. This case is presented by the important role of the dermatologist in the multidisciplinary management of the cancer patient. (AU)

Humans , Female , Middle Aged , M Phase Cell Cycle Checkpoints/drug effects , Immunotherapy/adverse effects , Antibodies, Monoclonal/adverse effects , Thyroxine/therapeutic use , Brain Neoplasms/complications , Brain Neoplasms/drug therapy , Thyrotropin/analysis , Carboplatin/administration & dosage , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/drug therapy , Tumor Suppressor Proteins/drug effects , Dermatology , Facial Injuries , Facial Paralysis , CTLA-4 Antigen/drug effects , CTLA-4 Antigen/physiology , Programmed Cell Death 1 Receptor/drug effects , Programmed Cell Death 1 Receptor/physiology , Pemetrexed/administration & dosage , Melanoma/complications , Melanoma/drug therapy , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/therapeutic use , Neoplasm Metastasis/drug therapy
Acta méd. costarric ; 60(3): 139-141, jul.-sep. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-949562


Resumen La hemofilia A es una enfermedad ligada al cromosoma X que predispone al sangrado. Se trata con Factor VIII, ya sea profilaxis o a demanda. La mayoría de países en el resto del mundo utilizan profilaxis, lo cual a la larga es más barato que tratar los pacientes cuando están con un sangrado activo. La producción de inhibidores del factor VIII es la complicación más común y seria del tratamiento. La inmunotolerancia (ITI) es la única opción de tratamiento que ha demostrado satisfactoriamente erradicar esta condición en los pacientes que desarrollan inhibidores, disminuyendo de esta manera no solo los inhibidores sino los costos del tratamiento. Se presenta un caso de inducción satisfactoria de inmunotolerancia con bajas dosis de factor VIII (FVIII) en un paciente pediátrico con hemofilia A severa. A pesar de que la inmunotolerancia se ha practicado antes en Costa Rica, un caso de estos nunca antes había sido publicado.

Abstract Hemophilia A is an X - linked bleeding disorder. It can be treated with Factor VIII prophylaxis or on demand treatment. Most countries in the world use prophylaxis as it is less expensive than treating patients when they are bleeding. The production of factor VIII inhibitors is the most common and serious complication of the treatment. Immune tolerance induction (ITI) is the only option of treatment when patients develop inhibitors proven to be successful to eradicate this condition, therefore decreasing inhibitors and costs. A case of a successful immune tolerance induction with low doses of factor VIII (FVIII) in a pediatric patient with severe hemophilia A and FVIII inhibitors is presented. Even though inmunotolerance has been practice before in our country, a case like this has never been published.

Humans , Factor VIII/therapeutic use , Hemophilia A/complications , Immunotherapy , Immunotherapy/adverse effects
Einstein (Säo Paulo) ; 16(2): eRC4030, 2018. tab, graf
Article in English | LILACS | ID: biblio-953153


ABSTRACT Immunotherapy-induced pneumonitis is a rare complication with incidence estimated around 3%. This disease is difficult to diagnose and has great morbidity. For this reason, it became a challenge for oncologists and emergencists. We reviewed the case of five patients who used anti-PD1 (program cell death receptor antagonist 1) for antineoplastic treatment and developed treatment-induced pneumonitis. All patients had respiratory problems because of immunotherapy and presence of ground-glass radiologic change. Among all patients, only one had grade 5 pneumonitis, and delaying to begin corticosteroid therapy and worsening in clinical picture led to patient death. Other four patients with symptomatic grade 2 pneumonitis underwent corticosteroid therapy and had improvement in clinical and radiologic picture. Two patients were treated after an episode of pneumonitis, and no new pulmonary complications were observed until the end of this study. Immunotherapy-induced pneumonitis, although uncommon, can be potentially fatal. Medical team has the responsibility to pay attention for most common symptoms of the disease such as cough and dyspnea and conduct an early diagnosis and effective early treatment with corticosteroids.

RESUMO A pneumonite secundária à imunoterapia é uma complicação rara, com incidência estimada em cerca de 3%. No entanto, trata-se de uma intercorrência de difícil diagnóstico e com grande morbidade, que tem se tornado um desafio para oncologistas e emergencistas. Foram revisados os casos de cinco pacientes que fizeram uso de anti-PD1 (program cell death receptor antagonist 1) para tratamento antineoplásico e que evoluíram com quadro de pneumonite induzida pelo tratamento. Todos os pacientes apresentaram sintomas respiratórios em vigência de tratamento, com imunoterapia e presença de alteração radiológica em vidro fosco. Dentre estes pacientes, apenas um apresentou pneumonite grau 5, com atraso na introdução de corticoidoterapia, indo a óbito em decorrência do quadro. Os outros quatro pacientes apresentaram pneumonite grau 2, sintomática, sendo tratados com corticoidoterapia e evoluindo com melhora clínica e radiológica. Dois pacientes mantiveram o tratamento após o episódio de pneumonite, sem novas complicações pulmonares posteriores, até o momento. A pneumonite induzida por imunoterapia, apesar de ser um evento pouco frequente, pode acarretar grande morbidade, além de ser potencialmente fatal, cabendo à equipe médica ter atenção aos sintomas mais comuns, como tosse e dispneia, para diagnóstico precoce e tratamento efetivo, com uso precoce de corticoide.

Humans , Male , Aged , Aged, 80 and over , Pneumonia/chemically induced , Antibodies, Monoclonal, Humanized/adverse effects , Immunotherapy/adverse effects , Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Pneumonia/drug therapy , Pneumonia/diagnostic imaging , Carcinoma/therapy , Adrenal Cortex Hormones/therapeutic use , Fatal Outcome , Antibodies, Monoclonal, Humanized/therapeutic use , Nivolumab , Lung Neoplasms/therapy , Middle Aged , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use
Braz. J. Pharm. Sci. (Online) ; 54(spe): e01007, 2018. graf, ilus
Article in English | LILACS | ID: biblio-974431


The use of serum containing polyclonal antibodies from animals immunized with toxins marked the beginning of the application of antibody-based therapy in late nineteenth century. Advances in basic research led to the development of the hybridoma technology in 1975. Eleven years later, the first therapeutic monoclonal antibody (mAb) was approved, and since then, driven by technological advances, the development of mAbs has played a prominent role in the pharmaceutical industry. In this review, we present the developments to circumvent problems of safety and efficacy arising from the murine origin of the first mAbs and generate structures more similar to human antibodies. As of October 2017, there are 61 mAbs and 11 Fc-fusion proteins in clinical use. An overview of all mAbs currently approved is provided, showing the development of sophisticated mAbs formats that were engineered based on the challenges posed by therapeutic indications, including antibody-drug conjugates (ADC) and glycoengineered mAbs. In the field of immunotherapy, the use of immunomodulators, bispecific mAbs and CAR-T cells are highlighted. As an example of promising therapy to treat infectious diseases, we discuss the generation of neutralizing monoclonal-oligoclonal antibodies obtained from human B cells. Scientific and technological advances represent mAbs successful translation to the clinic

Animals , Mice , Technological Development/classification , Antibodies , Antibodies, Monoclonal/analysis , Mice, Transgenic/classification , Immunotherapy/adverse effects
Int. braz. j. urol ; 43(4): 615-627, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-892856


ABSTRACT Background In order to induce a potent cytotoxic T lymphocyte (CTL) response in dendritic cell (DC)-based immunotherapy for bladder cancer, various tumor antigens can be loaded onto DCs. Objective The aim of this study was to establish a method of immunotherapy for male patients with non-muscle invasive bladder cancer (NMIBC), using bladder cancer-specific CTLs generated in vitro by DCs. Materials and Methods Monocyte-derived DCs from bladder cancer patients were induced to mature in a standard cytokine cocktail (IL-1β, TNF-α, IL-6, and PGE2: standard DCs, sDCs) or anα-type 1-polarized DC (αDC1) cocktail (IL-1β, TNF-α, IFN-α, IFN-γ, and polyinosinic:polycytidylic acid) and loaded with the UVB-irradiated bladder cancer cell line, T24. Antigen-loaded αDC1s were evaluated by morphological and functional assays, and the bladder cancer-specific CTL response was analyzed by cytotoxic assay. Results The αDC1s significantly increased the expression of several molecules pertaining to DC maturation, regardless of whether or not the αDC1s were loaded with tumor antigens, relative to sDCs. The αDC1s demonstrated increased production of interleukin-12 both during maturation and after subsequent stimulation with CD40L that was not significantly affected by loading with tumor antigens as compared to that of sDCs. Bladder cancer-specific CTLs targeting autologous bladder cancer cells were successfully induced by αDC1s loaded with dying T24 cells. Conclusion Autologous αDC1s loaded with an allogeneic bladder cancer cell line resulted in increased bladder cancer-specific CTL responses as compared to that with sDCs, and therefore, may provide a novel source of DC-based vaccines that canbe used in immunotherapy for male patients with NMIBC.

Humans , Male , Aged , Urinary Bladder Neoplasms/therapy , Dendritic Cells/immunology , T-Lymphocytes, Cytotoxic/immunology , Cytokines/therapeutic use , Immunotherapy/methods , Urinary Bladder Neoplasms/immunology , Cell Differentiation/immunology , Treatment Outcome , Cell Line, Tumor , Immunotherapy/adverse effects , Middle Aged
Oncol. clín ; 22(2): 46-51, 2017.
Article in Spanish | LILACS | ID: biblio-882464


La inmunoterapia vino para quedarse. Partiendo desde el melanoma, fue ganando terreno en tratamiento de otros tumores más prevalentes, razón por la cual actualmente es ineludible para el personal de la salud involucrado en el cuidado de pacientes oncológicos, conocer el manejo de los eventos adversos asociados a las drogas empleadas (AU)

Immunotherapy is here to stay. Moving from melanoma to the most prevalent tumors, in just a few years it becomes one of the first choices for the medical oncologist. It is for this reason that all the health care staff should be aware of the management of the adverse effects of the drugs involved (AU)

Humans , Immunotherapy/adverse effects , Toxicity , Hypophysitis
Article in English | WPRIM | ID: wpr-183058


OBJECTIVE: To evaluate the multiphase contrast-enhanced magnetic resonance (MR) imaging features of Bacillus Calmette-Guerin (BCG)-induced granulomatous prostatitis (GP). MATERIALS AND METHODS: Magnetic resonance images obtained from five patients with histopathologically proven BCG-induced GP were retrospectively analyzed for tumor location, size, signal intensity on T2-weighted images (T2WI) and diffusion-weighted images (DWI), apparent diffusion coefficient (ADC) value, and appearance on gadolinium-enhanced multiphase images. MR imaging findings were compared with histopathological findings. RESULTS: Bacillus Calmette-Guerin-induced GP (size range, 9-40 mm; mean, 21.2 mm) were identified in the peripheral zone in all patients. The T2WI showed lower signal intensity compared with the normal peripheral zone. The DWIs demonstrated high signal intensity and low ADC values (range, 0.44-0.68 x 10(-3) mm2/sec; mean, 0.56 x 10(-3) mm2/sec), which corresponded to GP. Gadolinium-enhanced multiphase MR imaging performed in five patients showed early and prolonged ring enhancement in all cases of GP. Granulomatous tissues with central caseation necrosis were identified histologically, which corresponded to ring enhancement and a central low intensity area on gadolinium-enhanced MR imaging. The findings on T2WI, DWI, and gadolinium-enhanced images became gradually obscured with time. CONCLUSION: Bacillus Calmette-Guerin-induced GP demonstrates early and prolonged ring enhancement on gadolinium-enhanced MR imaging which might be a key finding to differentiate it from prostate cancer.

Aged , Gadolinium , Humans , Image Enhancement , Immunotherapy/adverse effects , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy , Male , Middle Aged , Mycobacterium bovis/pathogenicity , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , Prostatitis/diagnosis , Retrospective Studies , Urinary Bladder Neoplasms/drug therapy
Rev. bras. colo-proctol ; 30(1): 92-94, jan.-mar. 2010.
Article in Portuguese | LILACS | ID: lil-549929


Dos diversos tratamentos da infecção anal pelo papilomavírus humano, uma opção é o imunomodulador imiquimode. Derivado da família imidazoquinolina, o imiquimode é quimioterápico e imuno-estimulante com atividade antitumoral e antiviral. A medicação é aplicada em esquema domiciliar, três vezes por semana em noites alternadas, por oito a 16 semanas. Os efeitos adversos locais são comuns, mas bem tolerados. A droga atinge remissão de 74 a 84 por cento, sendo completa entre 25 e 77 por cento dos doentes, com menor taxa de remissão completa e maior índice de recidiva em imunodeprimidos. Aguardamos estudos com grandes casuísticas para avaliar melhor a eficácia dessa medicação, incluindo a incidência de recidivas e o tempo livre de novas lesões.

Considering several kinds of treatments for human papillomavirus anal infection, the topical immune response modifier imiquimod is an option. An imidazoquinoline derivate, imiquimod is a chemotherapic drug and an immune stimulator with antitumoral and antiviral action. The medication is used at home, by patients, three times a week, in alternated nights, for eight to 16 weeks. Side-effects are common, but well tolerated. This drug reaches from 74 to 84 percent of remission, although from 25 to 77 percent are complete. There are lower complete remission and higher recurrence in immune compromised patients. Studies with more patients for better evaluation of this medication efficiency are needed, including those about recurrences and time free from new lesions.

Condylomata Acuminata/therapy , Immunologic Factors , Immunotherapy/adverse effects , Papillomavirus Infections
Medical Journal of Cairo University [The]. 2006; 74 (Supp. 2): 21-27
in English | IMEMR | ID: emr-79446


Though many therapies exist for alopecia areata, one of the most unique is topical sensitization. Sensitizers as DPCP offer an attractive treatment option for many patients with alopecia areata, including those who have previously failed more traditional treatments and those who have extensive disease. The present study was done to evaluate the efficacy and tolerability of DPCP in the treatment of AA. Twenty five patients with AA were included in this study and divided into two groups: Group I, consists of 20 patients divided into 2 subgroups [subgroup Ia, 10 AA patients of less than 50% scalp hair loss and subgroup Ib, 10 AA patients of more than 50% scalp hair loss]. Group II included five patients with AT. After sensitization with 2% DPCP, progressively higher concentrations, beginning at 0.001%, were applied weekly for 6 months. Collectively, 23 out of the twenty-five patients [92%] showed variable grades of hair regrowth; 17 patients [68%] showed complete hair regrowth, 4 patients [16%] showed patchy terminal hair regrowth, 2 patients [8%] showed sparse pigmented hair and 2 patients [8%] showed no response at all. Reported adverse reactions were occasional episodes of contact dermatitis, cervical lymphadenopathy, generalized pruritus and pigmentary changes. Topical sensitization with DPCP offers a unique therapeutic alternative to traditional treatments for AA. It also offers many advantages over other treatments in extensive AA

Humans , Male , Female , Immunotherapy/adverse effects , Follow-Up Studies , Treatment Outcome , Cyclopropanes/pharmacology
JPMA-Journal of Pakistan Medical Association. 2005; 55 (7): 306-308
in English | IMEMR | ID: emr-72710


Pemphigus vulgaris is a serious chronic mucocutaneous ailment. In recent decades advances in diagnostic and therapeutic measures have led to a significant decline in morbidity and mortality. However, with the advent of active and prolonged immunotherapy involving corticosteroids, there has been a rise in steroid-associated complications. This has led to significant concern globally over the sensible use of treatment regimen in pemphigus patients. We present a patient who underwent a massive pulmonary embolism following over usage of corticosteroid therapy for pemphigus vulgaris. Whilst the patient survived owing to timely assessment and aggressive surgical intervention, the need for cautious and judicious immunotherapy in pemphigus is emphasized

Humans , Female , Pemphigus/drug therapy , Pemphigus/immunology , Immunotherapy/adverse effects , Adrenal Cortex Hormones/adverse effects , Chronic Disease
Rev. méd. Chile ; 132(9): 1115-1126, sept. 2004. tab
Article in Spanish | LILACS | ID: lil-443212


An alternative strategy for cancer treatment is the manipulation of the immune system, denominated cancer immunotherapy. The immunotherapeutical use of cells of the immune system, like dendritic cells (DC), is being explored in different clinical protocols. Recently, we finalized a clinical phase I protocol, for the treatment of malignant melanoma, using DCs loaded with tumor lysates. Our results indicate that the subcutaneous application of DCs do not produce adverse effects. We also observed an increase of tumor specific T lymphocytes precursors in the blood, associated to hypersensitivity reactions (DTH) in 60% of the treated patients. In most cases, an stability in the disease was observed, although without a significant association between vaccination and survival. Additionally, therapies based on Interleukin-2 (IL-2) have been used with relative success in the treatment of some kind of tumors since 1985. However, problems associated to the toxicity of IL-2 still restrict its massive use. Our direct experience with the use of IL-2, indicates that low doses and its subcutaneous application, maintains the beneficial effects for patients, eliminating the adverse effects. Based on the accumulated evidence during last the five years, we decided to implement an optimized clinical protocol, which alternatively combines dendritic cells vaccines with the use of low doses of IL-2 for the reinforcement of the immunological system.

Humans , Cancer Vaccines , Dendritic Cells/immunology , Immunotherapy , /immunology , Melanoma/therapy , Skin Neoplasms/therapy , Antigens, Neoplasm/immunology , Cancer Vaccines , Dendritic Cells/transplantation , Enzyme-Linked Immunosorbent Assay , Hypersensitivity, Delayed , Immunotherapy/adverse effects , /adverse effects , /therapeutic use , T-Lymphocytes, Cytotoxic/immunology , Melanoma/immunology , Skin Neoplasms/immunology , Pulse Therapy, Drug
Urology Journal. 2004; 1 (2): 111-114
in English | IMEMR | ID: emr-69196


Newly developed malignancies in kidney transplanted patients are one of the complications attributed to immunosuppression. Kaposi sarcoma is an unusual malignancy in general population, but may develop in kidney transplanted patients with highly varying prevalence. Our aim is to evaluate the prevalence, clinical manifestations, and outcome of Kaposi sarcoma in kidney transplanted patients. Five hundred and eighty cases [330 male, 250 female] with a mean age of 38.2 were followed for 36 months [range 9 months to 10 years], visiting every two months. History taking and physical examination with emphasis on skin and mucosa were taken. Biopsy of suspicious skin, mucosal, and visceral lesions assigned by other paraclinical methods was performed. Except 7 cases which were HLA identical to donors, all patients were managed with cyclosporine, Azathioprine and Prednisolone. Fourteen patients [2.2%] developed Kaposi sarcoma [biopsy documented] which constituted 60% of all post-transplantation malignancies. They were 11 males and 3 females with a mean age of 41 years. Sarcoma developed 8 to 31 months after transplantation with an average of 18 months. Of these patients, 13 had skin involvement that one of them had pulmonary involvement too. Another patient had only abdominal involvement. Azathioprine was discontinued in all patients, and cyclosporine was reduced in skin affected patients. In patients with visceral involvement cyclosporine was discontinued and then chemotherapy was initiated. All 3 patients with visceral involvement didn't respond to chemotherapy and expired after 6 months. Of 11 patients with skin involvement, one had complete and 2 had incomplete remission of whom, one expired due to acute rejection. Renal function in 8 patients was acceptable, but 2 had impaired renal function, yet didn't need dialysis. Prevalence of Kaposi sarcoma in our patients is more than western countries. Visceral involvement is uncommon, but has poor prognosis. Reducing immunosuppression with discontinuation of Azathioprine and significant reducing cyclosporine dosage can cease skin evolvement, with preserving renal function in most of the patients

Humans , Male , Female , Adult , Adolescent , Child , Middle Aged , Aged , Sarcoma, Kaposi/epidemiology , Prognosis , Immunotherapy/adverse effects