TY - JOUR
T1 - Management of Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy
T2 - ASCO Guideline Update
AU - Schneider, Bryan J.
AU - Naidoo, Jarushka
AU - Santomasso, Bianca D.
AU - Lacchetti, Christina
AU - Adkins, Sherry
AU - Anadkat, Milan
AU - Atkins, Michael B.
AU - Brassil, Kelly J.
AU - Caterino, Jeffrey M.
AU - Chau, Ian
AU - Davies, Marianne J.
AU - Ernstoff, Marc S.
AU - Fecher, Leslie
AU - Ghosh, Monalisa
AU - Jaiyesimi, Ishmael
AU - Mammen, Jennifer S.
AU - Naing, Aung
AU - Nastoupil, Loretta J.
AU - Phillips, Tanyanika
AU - Porter, Laura D.
AU - Reichner, Cristina A.
AU - Seigel, Carole
AU - Song, Jung Min
AU - Spira, Alexander
AU - Suarez-Almazor, Maria
AU - Swami, Umang
AU - Thompson, John A.
AU - Vikas, Praveen
AU - Wang, Yinghong
AU - Weber, Jeffrey S.
AU - Funchain, Pauline
AU - Bollin, Kathryn
N1 - Publisher Copyright:
Copyright © 2022 American Society of Clinical Oncology. All rights reserved.
PY - 2021/12/20
Y1 - 2021/12/20
N2 - 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/supportivecare-guidelines.
AB - 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/supportivecare-guidelines.
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U2 - 10.1200/JCO.21.01440
DO - 10.1200/JCO.21.01440
M3 - Review article
C2 - 34724392
AN - SCOPUS:85122642487
SN - 0732-183X
VL - 39
SP - 4073
EP - 4126
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 36
ER -