Immune-related adverse events from immune checkpoint inhibitors in pediatric patients: A literature review and case series

Immune checkpoint inhibitors (ICIs) are used to treat many adult cancers and are now being used to treat select pediatric cancers. Many toxicities resulting from ICIs, also known as immune-related adverse events (IRAEs), have been reported in the adult literature. IRAEs in the pediatric population have not been as well-characterized as those in the adult population, making management more difficult for clinicians. Herein we briefly summarize the existing literature about ICI-related toxicities in the pediatric/young adult oncology population. We then describe four patients who were treated at our institution with ICIs and experienced significant IRAEs—pneumonitis, polyneuritis cranialis, antibody-mediated diabetes, and colitis. Patients were initially managed with supportive care, close monitoring, and thorough diagnostic workups to exclude other causes of clinical signs and symptoms (i.e., infection). Additional treatments included corticosteroids, intravenous immunoglobulin (IVIG), vedolizumab, infliximab, and/or discontinuation of ICI therapy. Pediatric/young adult patients being treated for cancer with ICIs should be monitored closely for IRAEs so that appropriate interventions are initiated promptly. Cases of IRAEs in this population should be reported in the literature. •Immune related adverse events occur in many pediatric patients treated with ICIs.•Polyneuritis cranialis is a rare neurologic IRAE that can be seen with ICIs.•IRAEs can be managed with corticosteroids, IVIG, and immunosuppressive agents.•Discontinuation of ICIs is the final step in managing IRAEs.