What are the precautions for taking Penpulimab?

Penpulimab (Penpulimab), as a new PD-1 immune checkpoint inhibitor, has shown good efficacy in the fields of relapsed/refractory classical Hodgkin lymphoma (cHL) and recurrent or metastatic nasopharyngeal carcinoma (NPC). However, as an immunotherapy drug, there are some important precautions during the use of penpilimab. Understanding and properly managing these risks is crucial to ensure the safety and efficacy of the treatment.

1. Monitoring and management of immune-related adverse reactions (irAEs)

Due to the mechanism of activating the body's immune system, penpilimab may cause immune-mediated adverse reactions in multiple systems, including but not limited to the following:

1) Immune-related pneumonia (pneumonitis)

Symptoms include dry cough, shortness of breath, chest pain, etc., which can be life-threatening in severe cases. If respiratory symptoms worsen during treatment, immediate evaluation and imaging examinations should be performed. If necessary, treatment with ampilimab should be suspended or terminated, and immunosuppressive treatments such as glucocorticoids should be given.

2) Immune-related hepatitis (hepatitis)

Regular monitoring is requiredLiver function indicators such as ALT, AST, and bilirubin are required. If liver function abnormalities of grade 3 or above occur, the drug should be discontinued and glucocorticoids should be used appropriately.

3) Immune-related endocrine disorders

Thyroid dysfunction (hypothyroidism or hyperthyroidism), new onset of diabetes, adrenal insufficiency, etc. are common. TSH, FT4, blood glucose and cortisol levels should be tested regularly.

4) Immune-related enteritis (colitis)

The main symptoms are diarrhea and abdominal pain, and severe cases can lead to colon perforation. Moderate to severe diarrhea requires prompt evaluation and intervention. Once grade 2 or above immune-related adverse reactions occur, suspension of ampilimab treatment should be considered based on the severity, and glucocorticoid treatment should be initiated if necessary, and the dose should be gradually reduced to discontinued.

2. Infusion Reactions

During the intravenous infusion of ampilimab, patients may experience infusion-related reactions, such as fever, chills, rash, hypotension, or dyspnea. Usually occurs during the first or first few infusions. To prevent reactions, premedication (such as antihistamines or antipyretic and analgesics) may be chosen depending on the patient's condition. If a serious infusion reaction occurs, the infusion should be stopped immediately and symptomatic treatment should be carried out.

3. Risk of combined infection

After the immune system is activated, patients are at risk of reactivation of some latent infections (such as tuberculosis, hepatitis B, and hepatitis C). Detailed infection screening should be performed before using amprilumab, including: tuberculin skin test or IGRA test, HBV, HCV serology test, HIV screening (if applicable); For patients who are positive for hepatitis B surface antigen or HBV DNA test, antiviral treatment should be considered and the viral load should be continuously monitored during amprilumab treatment.

4. Precautions for combined treatment

In some indications, pembrolizumab can be used in combination with chemotherapy drugs (such as first-line treatment of nasopharyngeal carcinoma). During combination therapy, one needs to be alert to the superimposed risk of unique adverse reactions of chemotherapy drugs (such as bone marrow suppression, gastrointestinal toxicity) and immune-related toxicity. Regular blood routine and biochemical indicators need to be monitored, and the dosage and regimen should be adjusted in a timely manner. In addition, concomitant use with other immunosuppressive drugs (such as high-dose glucocorticoids or immunosuppressants) may reduce the anti-tumor activity of pembrolizumab, and unnecessary concomitant use should be avoided.

Reference materials:https://pmc.ncbi.nlm.nih.gov/articles/PMC11189389/