Research progress on mechanisms and predictive biomarkers for immune-related adverse events

Abstract In recent years, immune checkpoint inhibitors (ICIs) have been widely used in patients with malignant tumors. While ICIs significantly improve the prognosis of cancer patients, immune-related adverse events (irAEs) also occur. It is currently believed that the occurrence of irAEs correlates with alterations in the body's autoimmune system function, including over-activation of the immune system and breakdown of autoimmune tolerance. The mechanisms involve direct activation of T cells, secondary B-cell defects or autoantibodies production, ectopic antigen or antigenic epitope spread, and genetic susceptibility. Understanding the mechanisms of these toxic reactions and clearing predictive biomarkers will limit their occurrence, improving the prognosis of cancer patients treated with ICIs and giving early intervention to reduce the risk and damage associated with their occurrence. This review will systematically list possible mechanisms for the occurrence of irAEs and promising predictive biomarkers, and summarize approaches for early intervention and treatment, suggesting possible future directions for follow-up research and clinical applications of irAEs.