Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline

• DOI: 10.1200/jco.2017.77.6385
• Publication Date: 2018-02-14T15:00:49Z
• Authors: Julie R. Brahmer; Christina Lacchetti; Bryan J. Schneider; Michael B. Atkins; Kelly J. Brassil; Jeffrey M. Caterino; Ian Chau; Marc S. Ernstoff; Jennifer M. Gardner; Pamela Ginex; Sigrun Hallmeyer; Jennifer Holter C...; Natasha B. Leighl; Jennifer S. Mammen; David F. McDermott; Aung Naing; Loretta J. Nastoupil; Tanyanika Phillips; Laura D. Porter; Igor Puzanov; Cristina A. Reichner; Bianca D. Santomasso; Carole Seigel; Alexander Spira; Maria E. Suarez-A...; Yinghong Wang; Jeffrey S. Weber; Jedd D. Wolchok; John A. Thompson
• Keywords: Guideline

Purpose To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events in patients treated with immune checkpoint inhibitor (ICPi) therapy. Methods A multidisciplinary, multi-organizational panel experts medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, urology, neurology, hematology, emergency medicine, nursing, trialist, advocacy was convened to develop clinical practice guideline. Guideline development involved a systematic review literature an informal consensus process. The focused guidelines, reviews meta-analyses, randomized controlled trials, case series published from 2000 through 2017. Results identified 204 eligible publications. Much evidence consisted observational data, series, reports. Due paucity high-quality events, recommendations are based expert consensus. Recommendations for specific organ system-based toxicity diagnosis presented. While varies according system affected, general, ICPi therapy should be continued close monitoring grade 1 toxicities, exception some neurologic, hematologic, cardiac toxicities. may suspended most 2 consideration resuming when symptoms revert or less. Corticosteroids administered. Grade 3 toxicities generally warrant suspension ICPis initiation high-dose corticosteroids (prednisone mg/kg/d methylprednisolone mg/kg/d). tapered over course at least 4 6 weeks. Some refractory cases require infliximab other immunosuppressive In permanent discontinuation is endocrinopathies that have been by hormone replacement. Additional information available www.asco.org/supportive-care-guidelines www.asco.org/guidelineswiki .