• Tim Cooksley, Avinash Gupta, Tamer Al-Sayed, and Paul Lorigan.
• The Christie NHS Trust, Wilmslow Road, Manchester, M20 4BX, United Kingdom. Electronic address: cooks199@hotmail.com.
• Eur. J. Cancer. 2020 May 1; 130: 193-197.

IntroductionImmune-mediated toxicities are potentially fatal and can affect virtually any organ system. The prevalence of immune-mediated toxicity in patients being treated with immune checkpoint inhibitors (ICIs) is well described. However, the reasons for presentation and the prevalence of immune-mediated toxicity in acutely unwell patients being treated with ICIs is less well described.Materials And MethodsA prospective analysis of all emergency presentations in patients being treated with ICIs was performed at a specialist oncology hospital in England from 20th May 2018 to 19th May 2019. The primary outcome measure was whether the emergency presentation related to an immune-mediated toxicity. Secondary outcome measures were length of stay associated with immune-mediated toxicities and 7- and 30-day mortalities related to these presentations.ResultsDuring the study period, 300 patients on ICIs presented. The most common primary presenting complaints were dyspnoea 59 (19.7%), diarrhoea 47 (15.7%) and fever 37 (12.3%). Ninety-eight (32.7%) patients were diagnosed with an immune-mediated toxicity of which colitis 38 (38.8%), hepatitis 19 (19.4%) and pneumonitis 14 (14.3%) were the most common. The mean length of inpatient stay for those diagnosed with an immune-mediated presentation was 7.1 (0-45) days compared with 6.2 (0-44) days in those without. Seven patients died within 7 days of the emergency presentation, of whom 2 died from immune-mediated toxicity.ConclusionsOne-third of cancer patients treated with ICIs admitted as an emergence had an immune-mediated toxicity and 2% died because of this. Acute care clinicians managing these patients need to be aware that immune-mediated toxicity is common in this patient population, but it can be challenging to differentiate these from other causes for emergency presentation.Copyright © 2020 Elsevier Ltd. All rights reserved.

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