As immune checkpoint inhibitor (ICPi) therapy is growing more common for patients with cancer, nurses and other medical staff need to know the right ways to manage immune-related adverse effects. In February 2018, the American Society of Clinical Oncology (ASCO) released guidelines to help standardize and share appropriate responses.
An expert panel reviewed 204 evidence-based publications; however, because there is little high-quality evidence on management of these events, recommendations are based on expert consensus.
The ASCO panel created a 38-page summary of recommendations
for diagnosing and managing adverse effects associated with ICPi treatment. In general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, with the exception of neurologic, hematologic, and cardiac toxicities.
Therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert to grade 1 or less.
Grade 3 toxicities generally warrant discontinuation of ICP is and the initiation of high-dose corticosteroids, with tapering over 4-6 weeks. Patients with unresolved grade 3 toxicities should be referred to a dermatologist.
Permanent discontinuation of ICP is is recommended with grade 4 toxicities, with the exception of endocrinopathies that have been controlled by hormone replacement. Patients with grade 4 toxicities require hospital admission and prompt evaluation by a dermatologist. Patient and family members should receive education about immunotherapies, their mechanism of action, and associated adverse effects to report.
Supportive care guidelines
from ASCO offers additional information, including a slide set and patient information sheet.