Bryan J Schneider1, Jarushka Naidoo2,3, Bianca D Santomasso4, Christina Lacchetti5, Sherry Adkins6, Milan Anadkat7, Michael B Atkins8, Kelly J Brassil6, Jeffrey M Caterino9, Ian Chau10, Marianne J Davies11, Marc S Ernstoff12, Leslie Fecher1, Monalisa Ghosh13, Ishmael Jaiyesimi14, Jennifer S Mammen15, Aung Naing6, Loretta J Nastoupil6, Tanyanika Phillips16, Laura D Porter17, Cristina A Reichner18, Carole Seigel19, Jung-Min Song20, Alexander Spira21, Maria Suarez-Almazor6, Umang Swami22, John A Thompson23, Praveen Vikas24, Yinghong Wang6, Jeffrey S Weber25, Pauline Funchain20, Kathryn Bollin26. 1. University of Michigan Health System, Ann Arbor, MI. 2. Beaumont Hospital, Dublin, Ireland. 3. Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD. 4. Memorial Sloan Kettering Cancer Center, New York, NY. 5. American Society of Clinical Oncology, Alexandria, VA. 6. MD Anderson Cancer Center, Houston, TX. 7. Washington University, St Louis, MO. 8. Georgetown Lombardi Comprehensive Cancer Center, Washington, DC. 9. The Ohio State University Wexner Medical Center, Columbus, OH. 10. Royal Marsden Hospital and Institute of Cancer Research, London & Surrey, Sutton, UK. 11. Smilow Cancer Hospital and Yale School of Nursing; New Haven, CT. 12. National Cancer Institute, Bethesda, MD. 13. University of Michigan, Ann Arbor, MI. 14. Cancer Care Associates PC, Royal Oak, MI. 15. Johns Hopkins University, Baltimore, MD. 16. City of Hope, Duarte, CA. 17. Patient Advocate, Colon Cancer Alliance, Washington, DC. 18. Georgetown University, Washington, DC. 19. Patient Advocate, MGH Cancer Center, Boston, MA. 20. Cleveland Clinic, Cleveland, OH. 21. Virginia Cancer Specialists and US Oncology, Fairfax, VA. 22. Huntsman Cancer Institute-University of Utah, Salt Lake City, UT. 23. Seattle Cancer Care Alliance, University of Washington/Fred Hutchinson, Seattle, WA. 24. University of Iowa, Iowa City, IA. 25. NYU Langone Medical Center, New York, NY. 26. Scripps MD Anderson Cancer Center, San Diego, CA.
Abstract
PURPOSE: To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS: A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS: A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS: Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines.
PURPOSE: To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS: A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS: A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS: Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines.
Authors: Ben Sprangers; David E Leaf; Camillo Porta; Maria José Soler; Mark A Perazella Journal: Nat Rev Nephrol Date: 2022-09-27 Impact factor: 42.439