Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Targeted therapies have revolutionized the management of hematological malignancies and solid organ cancers. These new treatments present numerous infectious complications. We aim to present the main infectious complications related to immune checkpoint inhibitors, Bruton's tyrosine kinase (BTK) inhibitors, phosphatidylinositol 3-kinase inhibitors (PI3K), antiapoptotic protein BCL-2 inhibitors, Janus kinase inhibitors and CAR-T cell infusion treatments. The knowledge of complications allows the physician to better identify patients at risk in order to implement diagnostic and therapeutic strategies, or to discuss the implementation of preventive measures. Background: Infections are well known complications of some targeted drugs used to treat solid organ cancer and hematological malignancies. Furthermore, Individual patient risk factors are associated with underlying pathologies, concomitant immunosuppressive treatment, prior treatment and use of anti-infective prophylaxis. Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Objectives: In this narrative review, we present the current state of knowledge concerning the infectious complications occurring in patients treated with immune checkpoint inhibitors (ICIs), Bruton's tyrosine kinase (BTK) inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, antiapoptotic protein BCL-2 inhibitors, Janus kinase inhibitors or CAR-T cell infusion. Sources: We searched for studies treating infectious complications of ICIs, BTK inhibitors, PI3K inhibitors, antiapoptotic protein BCL-2 inhibitors and CAR-T cell therapy. We included randomized, observational studies and case reports. Content: Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Treatment of irAEs with corticosteroids and other immunosuppressive agents can lead to opportunistic infections. Bruton's tyrosine kinase (BTK) inhibitors are associated with higher rate of infections, including invasive fungal infections. Implications: Infections, particularly fungal ones, are common in patients treated with BTK inhibitors even though most of the complications occurring among patients treated by ICIs or CART-cells infusion are associated with the treatment of side effects related to the use of these new treatments. The diagnosis of these infectious complications can be difficult and may require extensive investigations.