The Place of Therapeutic Apheresis in Severe Immune‐Related Adverse Events: A Scoping Review of Literature

Immune checkpoint inhibitors (ICIs) have revolutionized the management of patients with cancer. However, they can induce breakdowns in immunologic tolerance, leading to autoimmune diseases, or immune related adverse events (irAEs). These irAEs can sometimes be life threatening, requiring aggressive management, such as immunosuppressant (IS) or even therapeutic apheresis (TA). TA, an extracorporeal circulation technique, may represent a therapeutic option for severe irAEs, reducing their severity and duration by removing ICIs, pathogenic antibodies or inflammatory cytokines, although its role in this situation remains underreported. We made scoping review to better identify the use of TA for managing severe irAEs. From January 2022 to August 2025, three databases were reviewed, for articles mentioning the use of TA in the event of immunotoxicity. Only case reports or case series were retained. A descriptive summary was produced in table forms. Between 2022 and 2025, 162 articles were identified, 34 articles concerning 42 patients treated for severe irAE via TA were included. The underlying cancers were mainly non‐small cell lung cancer and melanoma, and 78% of patients were treated with monotherapy anti‐PD(L)1. The main indications for TA were neurological (40.6%), overlap manifestations (23.8%), and hepatitis (21.4%), mainly highly severe. TA was most often used in rescue situations, that is, after failure of several lines of IS. Complications of TA were rare. Clinical improvement was reported in most patients, usually within days of TA, with 24% complete resolution, and 45% partial resolution. Despite revolutionizing cancer treatment, ICIs induce severe irAEs, with poorly defined therapeutic options. TA may be a therapeutic option for life threatening irAEs, with data in the literature assuming its effectiveness. However, details on its use remain poorly defined. Further studies are required to emphasize its use as in irAEs.