Journal article
Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update
Journal of clinical oncology, Vol.39(36), pp.4073-4126
12/20/2021
DOI: 10.1200/JCO.21.01440
PMID: 34724392
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 .
Details
- Title: Subtitle
- Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update
- Creators
- Bryan J. Schneider - University of Michigan–Ann ArborJarushka Naidoo - Beaumont HospitalBianca D. Santomasso - Memorial Sloan Kettering Cancer CenterChristina Lacchetti - American Society of Clinical OncologySherry Adkins - The University of Texas MD Anderson Cancer CenterMilan Anadkat - Washington University in St. LouisMichael B. Atkins - Georgetown UniversityKelly J. Brassil - The University of Texas MD Anderson Cancer CenterJeffrey M. Caterino - The Ohio State University Wexner Medical CenterIan Chau - Royal Marsden NHS Foundation TrustMarianne J. Davies - Smilow Cancer HospitalMarc S. Ernstoff - National Cancer InstituteLeslie Fecher - University of Michigan–Ann ArborMonalisa Ghosh - University of Michigan–Ann ArborIshmael Jaiyesimi - Cancer Care Associates PC, Royal Oak, MI.Jennifer S. Mammen - Johns Hopkins UniversityAung Naing - The University of Texas MD Anderson Cancer CenterLoretta J. Nastoupil - The University of Texas MD Anderson Cancer CenterTanyanika Phillips - City Of Hope National Medical CenterLaura D. Porter - Patient Advocate, Colon Cancer Alliance, Washington, DCCristina A. Reichner - Georgetown UniversityCarole Seigel - Patient Advocate, MGH Cancer Center, Boston, MA.Jung-Min Song - Cleveland ClinicAlexander Spira - Virginia Cancer SpecialistsMaria Suarez-Almazor - The University of Texas MD Anderson Cancer CenterUmang Swami - Huntsman Cancer InstituteJohn A. Thompson - Seattle Cancer Care AlliancePraveen Vikas - University of IowaYinghong Wang - The University of Texas MD Anderson Cancer CenterJeffrey S. Weber - NYU Langone HealthPauline Funchain - Cleveland ClinicKathryn Bollin - Scripps MD Anderson Cancer Center
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.39(36), pp.4073-4126
- DOI
- 10.1200/JCO.21.01440
- PMID
- 34724392
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 12/20/2021
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359811002771
Metrics
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