Although immune-mediated colitis is well known and is one of the most common toxicities of Immune Checkpoint Inhibitors (ICIs), the toxicity of these agents to the upper digestive tract is largely unknown and its incidence is probably underestimated. It can affect the stomach and/or the duodenum, and much more rarely the esophagus. Involvement of several segments is common, as is the association with colitis and possibly extra-digestive toxicity(ies). Severity is extremely variable, but severe forms are possible, particularly due to hydro-electrolytic and nutritional repercussions, possible haemorrhagic complications, and much more rarely, a risk of perforation. Many differential diagnoses must be considered. Therapeutic modalities are partly modeled on those of colitis, and the choices must be discussed and validated in multidisciplinary meetings, taking into account the entire "spectrum" of toxicity. We propose a review of the data available in the literature concerning the toxicity of ICIs on the upper digestive tract, illustrated by a few cases from our center.

Chemotherapy drugs affect the cells of everyone who comes into contact with them, including patients and healthcare professionals. Protective measures must be implemented systematically.

Prostate cancer mainly affects older men and is treated with hormone therapy, often in combination with other treatments. Particular attention must be paid to the side effects of treatments that impact patients' quality of life. Comprehensive care and regular monitoring by a multidisciplinary team supported by supportive oncology care, coordinated by an advanced practice nurse or coordinating nurse, ensure optimal and safe care.

Medication-related osteonecrosis of the jaw is a rare but severe complication of antiresorptive or antiangiogenic treatments. Prevention relies on patient education, dental screening prior to therapy, and avoidance of invasive procedures. Diagnosis is based on clinical and radiological criteria, with classification into four stages. Management is multidisciplinary and adapted to disease stage: strict oral hygiene, antibiotics, sequestrectomy, or reconstructive surgery. Regular follow-up and close communication among healthcare providers are key to controlling disease progression and maintaining patients' quality of life.

As the number of cancer treatments increases, new specific toxicities are emerging, requiring early and specialized treatment. The Gustave-Roussy center in Villejuif, near Paris, has set up a multidisciplinary toxicity pathway (ImmunoTox multidisciplinary consultation meeting, day hospital, mobile team). This includes an advanced practice nurse to optimize the management of undesirable effects, improve quality of life and mobilize all related skills.

The harmonization workshops of the leukemia committee of the Société française des cancers de l'enfant (SFCE) aim to establish practical recommendations based on the one hand, on data from the literature and international recommendations and, on the other hand, by consensus in the absence of formally proven data. Adolescent pubescent girls and young adults undergoing intensive chemotherapy treatment may present with heavy uterine bleeding (HUB). Data collected from 25 French centers showed that there was considerable heterogeneity in the management of HUB either in prophylaxis or curative strategy. Analysis of the literature showed that, given the incidence of spontaneous amenorrhea during chemotherapy treatment, there is no indication for systematic prophylaxis of HUB in patients treated for leukemia. In case of proven HUB, non-hormonal treatment and hormonal treatment can be introduced as a matter of urgency. For secondary prophylaxis, various hormonal treatments aiming at achieving prophylactic amenorrhea may be discussed.

Oral adjuvant hormone therapy for early breast cancer, despite its proven importance in terms of survival and prevention of recurrence, does not fall within the scope of clinical pharmacy programs set up for oral anticancer drugs, even though issues of therapeutic adherence have been clearly identified. The aim of our study was to explore the perception of healthcare professionals regarding the prescription and dispensing of this hormone therapy, in order to identify the risks for these patients and determine the clinical pharmacy actions that could address these risks.

Therapeutics used in cancer treatment can cause vestibular ototoxicity, which is particularly challenging to detect due to the frequent occurrence of nausea and vomiting in patients experiencing significant fatigue and stress. An appropriate diagnosis enables optimal symptom correction, reduces the risk of falls, and improves quality of life.

Immune checkpoint inhibitors are now an essential therapy for lung cancer. These monoclonal antibodies are nevertheless responsible for immune-related adverse events. With particular regards for patients with previous autoimmune disease, less is known about the efficacy and safety of immune checkpoint inhibitors, but also about the consequences of steroids or other specific therapies. The aim of this article is to synthesize available data in the literature on immune checkpoint inhibitors experience in patients with both lung cancer and autoimmune disease.

Cancer remains a significant public health concern globally, with increasing incidence in developing countries like India. While chemotherapy has improved survival rates, the quality of life and psychological well-being of cancer patients frequently deteriorate due to treatment-related toxicities, including electrolyte disturbances and psychological effects. This study aimed to examine the differential impact of platinum-based chemotherapy versus other regimens on Health-related Quality of Life (HRQoL) and Hospital Anxiety and Depression Scale (HADS) scores in cancer patients.

This review aims to evaluate the incidence, clinical impact, and available therapeutic options for the management of gynecomastia induced by hormonal therapy, particularly in the era of androgen receptor pathway inhibitors, in patients with prostate cancer. We analysed data from clinical trials evaluating the incidence of gynecomastia under androgen receptor pathway inhibitors and the efficacy of both prophylactic and curative strategies, primarily tamoxifen and male breast radiotherapy, in patients receiving bicalutamide. Androgen receptor pathway inhibitors monotherapy is associated with high rates of gynecomastia (34 to 55 %), whereas combining androgen receptor pathway inhibitors with chemical castration significantly reduces this risk. Prophylactic tamoxifen significantly decreases gynecomastia incidence (down to 10 % versus 73 % without treatment) with good overall tolerance; prophylactic breast radiotherapy also shows efficacy. In the curative setting, tamoxifen appears more effective than radiotherapy, while surgery remains an invasive fallback option. However, extrapolating results obtained with bicalutamide to second-generation androgen receptor pathway inhibitors remains uncertain due to pharmacological and clinical differences. Gynecomastia could become a major complication of androgen receptor pathway inhibitors monotherapy. To date, tamoxifen and prophylactic breast radiotherapy are the most validated strategies, with the former appearing more effective. Further studies are needed to confirm their specific efficacy and safety in patients treated with androgen receptor pathway inhibitors.

Breast cancer is the most common cancer among women of childbearing age. Despite potentially gonadotoxic treatments, fertility following breast cancer treatment remains satisfactory. Oncofertility has advanced, and an increasing number of patients benefit from oocyte or embryo cryopreservation techniques. Nevertheless, the majority of pregnancies occur spontaneously. Pregnancy does not increase the risk of recurrence, nor does it decrease the overall survival of women, regardless of nodal status or hormone receptor status. Obstetrically, women treated for breast cancer achieve as many live births as the general population, despite an increased incidence of obstetric complications. Breastfeeding is possible and does not appear to affect survival or increase the risk of recurrence. Thus, the most recent data are reassuring regarding the possibility and safety of pregnancy after breast cancer. However, questions remain concerning the management of treatments in the context of a desire for pregnancy. The benefit of combining GnRH agonists with chemotherapy to improve pregnancy chances is being questioned. The interruption period for tamoxifen in an adjuvant setting needs clarification. Finally, new data are required for patients treated with immunotherapy, PARP inhibitors, or cell cycle cyclin inhibitors.

Immune checkpoint inhibitors (ICI) have revolutionized the treatment of solid tumors. However, they can induce immune-related adverse effects (irAEs) that can affect any organ. These irAEs are different from the side effects of traditional oncological treatments and require specific management. Given the increasing use of ICI, first-line care will increasingly need to manage these irAEs. This article aims to assist in the implementation of the guidelines for managing irAEs, with a particular focus on aspects related to first-line care.

Pembrolizumab, a humanized monoclonal antibody targeting PD-1 (programmed cell death protein 1), is employed for various cancers but can induce immune-related adverse events (irAEs) resembling autoimmune or inflammatory conditions. We present the case of a 44-year-old female with lung cancer treated with pembrolizumab who developed lichen sclerosus (LS). Cases of LS related to immune checkpoint inhibitors (ICIs) have been documented, primarily in women. High-potency topical steroids achieve favorable outcomes without immunotherapy discontinuation. Monitoring the development of malignancies is essential, as LS patients face a high-risk of developping squamous cell carcinoma.

Drug-induced immune thrombocytopenia (DIIT) is a rare cause of immune thrombocytopenia, characterized by the formation of drug-dependent antiplatelet antibodies. DIIT can lead to life-threatening hemorrhage. The diagnosis is difficult, relying on the detection of antiplatelet antibodies in patient's serum exclusively in the presence of the implicated drug. The gold standard test is the monoclonal antibody immobilization of platelet antigens (MAIPA), although other techniques (flow cytometry and Luminex®) can be used.

The rapid evolution of oncological treatments in patients with lung cancer has led to the emergence of targeted therapies (TT), immune checkpoint inhibitors (ICI), and antibody-drug conjugates (ADC), which are significantly transforming the management of cancer. However, these advances are associated with complex adverse effects that affect multiple organ systems. This review explores the etiopathogenic mechanisms underlying therapy-related toxicity and describes the major adverse effects: immune-related toxicity of ICIs, "on-target" and "off-target" effects of TTs, and systemic toxicity of ADCs. Systemic toxicities are discussed, with a focus on monitoring strategies and management approaches. A multidisciplinary approach is critical to optimize therapeutic efficacy while minimizing toxicity.

Lung cancer is a common disease with a high mortality rate. It is often diagnosed at an advanced stage, with a median survival of 12 to 16 months. Immune checkpoint inhibitors are part of the first-line therapeutic armoury in metastatic stages. They have been shown to improve overall survival, including in patients aged 64 to 75, but the results are less clear in older patients, who are underrepresented in clinical trials. Although the management of adverse events associated with these treatments is now well protocolized, the accumulation of toxicities, even low-grade toxicities, can have an adverse impact on the quality of life of the most frail elderly patients. Geriatric assessment is essential for adapting treatments and anticipating adverse effects.

Multiple myeloma (MM) is the 2nd most common haematological malignancy in France, and its treatment has been improved in recent years by the arrival of new therapies such as CAR-T cells and bispecific antibodies. Among the latter, teclistamab, indicated as a 4th-line treatment for relapsed or refractory MM patients, targets the CD3 antigen on the surface of T lymphocytes and the BCMA antigen on the surface of malignant plasma cells. The adverse reactions to teclistamab described in the summary of product characteristics (SPC) mention hypogammaglobulinemia, leading to recurrent infections. Immunosubstitution with normal human immunoglobulin (HN-Ig) is often necessary. However, these drugs are regularly in short supply, and are subject to prioritisation recommendations. Until now, immunosubstitution in myeloma has been a "non-priority" indication, to be assessed according to the criteria of the French National Agency for the Safety of Medicines and Health Products (ANSM). The aim of this study was to analyse the management of hypogammaglobulinaemia in the context of teclistamab treatment in our institution over a one-year period during post-marketing authorisation (MA) early access (AP2). Patient characteristics and clinical data related to treatment with teclistamab and HN-Ig (dose, route of administration, frequency, and time to post-teclistamab initiation for HN-Ig, first infection and its type prior to immunosubstitution and its time to onset relative to teclistamab initiation) were extracted from patient records. In order to analyse compliance with the recommendations for prioritisation of HN Ig indications, blood Ig G levels were recorded (at the time of teclistamab initiation, one month later, 3 months later, and 6 months after the start of teclistamab treatment). The quantities in total grams of Ig HN consumed in hospital and aftercare as part of teclistamab treatment and in all DIS indications combined were also investigated. Among the 35 patients treated with teclistamab, 24 received HN Ig as a replacement after an average of 1 month of treatment. At least one infection occurred in 13 of these patients approximately 1 month after initiation of teclistamab. Bacterial infections accounted for 75 % of these infections, mainly pneumonia, bronchitis and urinary tract infections. In 96 % of patients, HN Ig was administered intravenously at a dose of 0.4g/kg each month. Only one patient was treated with weekly subcutaneous Ig HN at a dose of 0.1g/kg. Only 50 % of patients treated with HN Ig met the prioritisation criteria defined by the ANSM (latest recommendations April 2019). Despite immunosubstitution, IgG levels remained relatively stable over time, with a median of 2.6g/L at the start of teclistamab treatment. The time to initiation of immunosubstitution only shortened over time, from 3 months at the start of the study to 0 months, and then to systematic initiation of IS from the start of teclistamab. In terms of consumption, the use of HN-Ig to compensate for post-teclistamab hypogammaglobulinaemia represented 33 % of the total consumption of HN-Ig for secondary immunodeficiency. In conclusion, the systematic introduction of Ig HN immunosubstitution seems necessary to prevent infections following teclistamab treatment in patients with proven hypogamaglobulinaemia. This new practice is likely to have a major impact on the consumption of these plasma-derived medicinal products, which are already often in short supply.

Lyme borreliosis is suspected when there are compatible symptoms associated with tick exposure. The diagnosis, except for erythema migrans, is based on serology. However, in some cases, serology may be erroneous.

Febrile neutropenia is a medical emergency requiring rapid and rigorous management considering the risk of severe infection. Febrile neutropenia is a frequent complication in patients receiving chemotherapy. Initial assessment is vital in order to decide the follow-up (outpatient treatment, conventional care or intensive care unit) and to initiate adapted antibiotic therapy as soon as possible. Depending on the infectious syndrome (clinically documented, microbiologically documented or undocumented), antibiotic therapy should be adapted or discontinued, considering the recovery from aplasia and absence of fever. Antifungal agents are not systematically used and its use should be discussed according to the context. G-CSF should be used prophylactically, and is not an adjunct to antibiotic therapy for febrile neutropenia. Granulocyte transfusions are exceptionnally indicated and its use should be discussed on a case-by-case basis. Standard precautions are adequate for the majority of patients, with the exception of specific situations.