Inibidores de checkpoint imunológico em pacientes oncológicos sob a perspectiva da atenção farmacêutica – uma revisão integrativa

Abstract

Pharmaceutical care is integrated with cancer patient care, from antineoplastic drug control to clinical follow-up and oncological therapeutic implications. Immunological checkpoint inhibitors (ICIs), a kind of immunotherapy using monoclonal antibodies used in the treatment of various types of malignancies, are among the potential new therapeutic options in the oncological field. Although promising, the toxicity of ICIs, such as immune system-related adverse events (irEAs), can impact the outcome of treatment. The pharmacist is the professional who seeks to prevent, identify and solve problems related to medicines, thus being essential for the care of the oncological patient in treatment with ICIs. The aim of this work was to assess the contribution of the pharmacist in the therapeutic monitoring of the oncological patient in treatment with ICIs. In this way, an integrative review of studies of oncological patients treated with ICIs and that had the participation of the pharmacist was carried out in the databases: Pubmed, Scopus, Embase and Web of Science using the MeSH terms for cancer, immune checkpoint inhibitors and pharmaceutical care. The studies were selected based on the inclusion and exclusion criteria, extracting general data from each study, data on the population, specific data and data related to the pharmacist's participation. 2152 studies were obtained, of which 81 studies were selected for the evaluation of the full text. Following this analysis, nine studies with a total of 916 participants were chosen and included in this integrative review, and the average age was over 60 years old. The major general adverse events presented were nausea, vomiting, diarrhea and fatigue, and the most frequent irEAs in the studies were pneumonitis, hepatitis, thyroid dysfunction, colitis and dermatites. Pharmaceutical care has been present in patient care through medication recommendations, monitoring and management of toxicities, pharmaceutical consultations, patient guidance, caregivers, physicians, and multidisciplinary staff, as well as activities that helped to identify toxicities early and alleviate symptoms. Some studies highlighted that pharmaceutical interventions contributed to around 70% improvement in irEAs symptoms. The assessed studies included significant information that may aid in the creation of individualized pharmaceutical care for patients receiving ICIs for cancer treatment. However, there is still a limitation in the details of some information, signaling the need for more and more specific studies for this patient profile. Thus, it is concluded that pharmaceutical care in the context of oncological immunotherapy with ICIs can provide positive impacts both for health institutions, by reducing costs or minimizing waste, and, mainly, for patients, in the outcome of treatment and in improving the quality of life. Keywords: pharmaceutical care, cancer, immunotherapy, immune checkpoint inhibitors, toxicity.