This chapter provides an overview of cancer immunotherapy, tracing its evolution from historical observations to cutting-edge therapies like immune checkpoint inhibitors, CAR T-cell therapy, and bispecific T-cell engagers. We explain how these treatments harness or modify the immune system to target cancer, detailing their mechanisms, clinical applications, and associated toxicities across multiple organ systems. Key agents include CTLA-4 and PD-1/PD-L1 inhibitors, high-dose IL-2, interferons, and therapeutic vaccines like Sipuleucel-T. As these drugs can potentially impact every organ system, thoughtful anesthetic planning for the care of cancer patients is critical for minimizing complications. We emphasize the importance of assessing immune-related adverse events (irAEs) such as pneumonitis, myocarditis, neurotoxicity, and endocrinopathies through preoperative planning and throughout the perioperative period. We advocate for close coordination with oncology and surgical teams to optimize perioperative care. Emerging therapies and future directions—including novel checkpoint inhibitors, CAR-NK cells, and oncolytic viruses—are also discussed, highlighting the field's rapid growth and evolving clinical impact.
Keywords: Anesthetic risk stratification, Bispecific T-cell engagers, BiTEs, Chimeric Antigen Receptor Cells, CAR T-Cells, Immunosuppression, Myasthenia Gravis-like syndrome, Neuropathy, Oncologic anesthesia, Regional anesthesia, Tumor immunology, Vaccines.
