Mechanism and Management of Checkpoint Inhibitor-Related Toxicities in Genitourinary Cancers

SIMPLE SUMMARY: Immune therapy using checkpoint inhibitors has been increasing in genitourinary cancers for the past decade, starting with monotherapy in renal cell carcinoma and urothelial carcinoma to now include many first-line combinations. More combinations and FDA/EMA indications are undoubtedly on the horizon. An increasing number of patients will be treated with these therapies in the future resulting in a significant increase in the prevalence of immune mediated toxicities. This manuscript focuses on the current understanding of immunotherapy related adverse effects in genitourinary malignancies encountered with the use of immune checkpoint inhibitors. ABSTRACT: The use of immune checkpoint inhibitors (ICIs) is rapidly increasing as more combinations and clinical indications are approved in the field of genitourinary malignancies. Most immunotherapeutic agents being approved are for the treatment of renal cell carcinoma and bladder cancer, which mainly involve PD-1/PD-L1 and CTLA-4 pathways. There is an ongoing need for recognizing and treating immunotherapy-related autoimmune adverse effects (irAEs). This review aims to critically appraise the recent literature on the mechanism, common patterns, and treatment recommendations of irAEs in genitourinary malignancies. We review the epidemiology of these adverse effects as well as general treatment strategies. The underlying mechanisms will also be discussed. Diagnostic considerations including differential diagnosis are also included in this review.