Pharmaceutical care, cancer, immunotherapy, immune checkpoint inhibitors, toxicity

Pharmaceutical care is integrated with cancer patient care in a variety of ways, ranging
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. However,
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. 2152 studies were obtained, of which 52 studies were selected for
the evaluation of the full text on the basis of inclusion and exclusion criteria. Following
this analysis, eight studies with a total of 739 participants (68% male and 32% female)
were chosen and included in this integrative review. Participants in six research had
an average age of more than 60 years. The most common type of cancer was lung
cancer, followed by melanoma. The immunological toxicity of ICIs was observed in
various body systems. Pharmaceutical care has been present in patient care through
prescription-free 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. 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.