1. Although immune related myasthenia gravis (irMG) is a rare complication of immune checkpoint inhibitors, its associated morbidity and mortality is extremely high and knowledge of and identification of this complication is important.

2. Patients with irMG almost always require admission for observation and treatment as their initial symptoms may not reflect how quickly they can proceed to life threatening complications such as respiratory failure.

3. Consider concurrent immune related adverse events in patients presenting with irMG, including myositis, myocarditis, hepatitis, pneumonitis, and peripheral neuropathy.

4. Treatment often requires steroids as well as IVIG and PLEX.

5. In patients that you are worried about myositis, also consider other potential causes, including medications like statins that could be contributing.

1. Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) represent a spectrum of inflammatory side effects associated with T-cell targeted therapies, such as CAR-T.

2. Patients with CAR-T related CRS and/or ICANS toxicities have favorable prognosis and are expected to recover without persistent side-effects if symptoms are recognized early and managed rapidly. These toxicities are relatively reversible and require prompt collaboration between the ED provider, oncologist, and other specialists.

3. The American Society for Blood and Marrow Transplantation (ASTCT) grading scale is commonly utilized to characterize the severity of CRS and ICANS with management recommendations based on severity grade.

4. IL-6 inhibitors such as tocilizumab do not cross the blood-brain barrier and should not be used for ICANS treatment unless there is concomitant CRS.

5. Consider early transfer for higher level of care, even if patient has a low CRS grade, if IL-6 inhibitors are not available for administration at your hospital.

1. It is important to consider immune-related adverse events in patients coming in with new cutaneous reactions, even in patients who have not recently started a new immunotherapy regimen, as reactions can occur months later.

2. Pruritus and morbilliform rashes tend to be the most common adverse event related to immunotherapy, and often do not require interruption of treatment.

3. Red flags of more severe cutaneous adverse events include mucous membrane involvement, skin sloughing, large body surface area involvement, end organ dysfunction, presence of bullae, and associated fever.

4. Treatment will vary by Grade and includes topical steroids and antipruritic medications, as well as oral antihistamines.

5. Diagnosis may require Dermatology consultation and skin biopsy. Progression of cutaneous toxicities with serial photographs can be helpful in evaluating immune related cutaneous adverse events.

1. Colitis secondary to an immune related adverse event can occur at any time during the course of treatment, including years after treatment has been completed.

2. Having a high index of suspicion in patients treated or previously treated with immunotherapy is important since symptoms may present subtly.

3. Grade 2 colitis and higher often require steroids for treatment; consider second line treatments in those that are not responding appropriately to steroids.

4. In grade 3 colitis, immunotherapy is typically paused until steroids have been tapered to less than 10 mg per day, but require weighing the risks and benefits of resuming treatment with immunotherapy.

5. Grade 4 colitis requires cessation of immunotherapy treatment.

Therapeutic radiation is essential for cancer treatment, particularly in brain tumors. Modern advancements such as linear accelerators, MRI/PET/CT imaging, and intensity-modulated radiotherapy (IMRT) have improved precision and reduced normal tissue toxicity. Radiation modifiers, agents that enhance tumor cell killing or protect normal tissues, have been developed to optimize radiation therapy. Historical approaches include oxygen therapy and nitroimidazole compounds, while contemporary strategies involve radiosensitizing chemotherapy, molecular agents, and nanotechnology. Future developments focus on targeted molecular agents, tumor-treating fields (TTF), ketogenic diets, and immunotherapy. Despite progress, managing brain tumors remains challenging due to normal tissue toxicity and the need for further research to enhance therapeutic outcomes.

Major advances over the past decades have transformed the management landscape of neuromuscular disorders. Increased availability of genetic testing, innovative therapies that target specific disease pathways and mechanisms, and a multidisciplinary approach to care including both transitional and palliative care contribute to timely and more appropriate management of conditions that are associated with a severe disease burden and often also a reduction of life expectancy.

There is an increasing number of consensus recommendations/guidelines that are a useful adjunct for establishing a timely and accurate diagnosis, and enable prognostication of disease-related complications, are a guide for multidisciplinary care and treatment, and expedite initiation of disease-modifying interventions. A number of these guidelines have been referred to in various cases, such as myasthenia gravis (MG), myotonic dystrophy type 1 and 2, chronic inflammatory demyelinating neuropathies (CIDP), and Duchenne muscular dystrophy (DMD), to name a few.

In the years following FDA approval of direct-to-consumer, genetic-health-risk/DTCGHR testing, millions of people in the US have sent their DNA to companies to receive personal genome health risk information without physician or other learned medical professional involvement. In Personal Genome Medicine, Michael J. Malinowski examines the ethical, legal, and social implications of this development. Drawing from the past and present of medicine in the US, Malinowski applies law, policy, public and private sector practices, and governing norms to analyze the commercial personal genome sequencing and testing sectors and to assess their impact on the future of US medicine. Written in relatable and accessible language, the book also proposes regulatory reforms for government and medical professionals that will enable technological advancements while maintaining personal and public health standards.

Provides an overview of the categories of cancer treatment modalities consisting of chemotherapy, stem cell transplant, hormone, immunotherapy, radiation, targeted cell therapy

Provides an overview of the categories of cancer treatment modalities consisting of chemotherapy, stem cell transplant, hormone, immunotherapy, radiation, targeted cell therapy

Provides an overview of the categories of cancer treatment modalities consisting of chemotherapy, stem cell transplant, hormone, immunotherapy, radiation, targeted cell therapy

Provides an overview of the categories of cancer treatment modalities consisting of chemotherapy, stem cell transplant, hormone, immunotherapy, radiation, targeted cell therapy

Provides an overview of the categories of cancer treatment modalities consisting of chemotherapy, stem cell transplant, hormone, immunotherapy, radiation, targeted cell therapy

Provides an overview of the categories of cancer treatment modalities consisting of chemotherapy, stem cell transplant, hormone, immunotherapy, radiation, targeted cell therapy

Despite the success in various other cancer types, there are no approved immune therapies for ovarian cancer, as response of ovarian cancer to immunotherapies thus far have been modest. Early studies of single agent anti-PD-1 antibodies in patients with platinum-resistant or recurrent ovarian cancer demonstrated response rates of between 8–15%. Combination strategies combining PD-1 or PD-L1 antibodies with anti-CTLA-4 antibodies have demonstrated slightly higher response rates of over 30%. Additional studies including chemotherapy in combination with immune checkpoint inhibitors (ICI) have shown no additional benefit of addition of ICI to traditional chemotherapy regimens. We argue that outside of a clinical trial, there is no evidence to support routine usage of ICIs in EOC, even in a heavily pretreated platinum-resistant setting, although we are hopeful that biomarkers that may predict response to ICIs in ovarian cancer may be identified in the future. Lastly, we anticipate that emerging approaches in ovarian cancer immunotherapy such as novel ICI combinations, antibody-drug conjugates, bispecific antibodies, cytokines, and adoptive cell therapies will prove to be successful and look forward to the results of these studies.