Résumé
Background: immune checkpoint inhibitors (ICIs), represent a breakthrough in the management of oncology patients. These antibodies designed restore immune response, can lead to autoimmune manifestations. These immune related adverse events (irAEs) can sometimes be severe or life-threatening, requiring aggressive management, such as the use of immunosuppressants or even therapeutic plasmapheresis (TP). TP is an extracorporeal circulation technique, that could be the treatment of choice for severe irAEs, by eliminating the drug, pathogenic antibodies and inflammatory cytokines. We conducted a study to investigate the role and implementation of TP in the context of severe immunotoxicity. Methods: we reviewed our regional database concerning patients with irAEs from 2018 to 2024, from which were extracted patients who experienced severe immunotoxicity (CTCAE grade ≥3) treated with TP. We performed descriptive analysis and then comparative analysis with a control group. Results: 37 patients in TP group were analyzed, from which 3/4 received anti-PD(L)1 and 1/4 a combined immunotherapy. irAEs treated with TP included 51.3% neuromuscular and cardiac forms (myocarditis, myositis, myasthenia and overlap forms), 35% neurological events (encephalitis, PRNA), and 13.7% renal and hepatic involvement; and ¼ were managed in intensive care. 57% of patients had TP in rescue after failure of several lines of immunosuppressants. Patients received mainly 5 TP sessions, with a median time to resolution of 26.5 days. There was no significant difference in terms of resolution with the control group, but TP patients were significantly more severe. Conclusion: ICI can lead to severe irAEs, with still limited therapeutic options. TP could represent a treatment of choice for severe and life threatening irAE, but need further prospective studies to emphasize its effectiveness and evaluate the benefit/risk ratio of such a therapeutic option.