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How to Handle Adverse Effects Associated with Immune Checkpoint Inhibitors

LISA SCHULMEISTER, MN, RN, FAAN
Monday, April 09, 2018
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.
 

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN
 
Blog Info
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.
Author Bio
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, is the Editor-in-Chief for OncLive Nursing. She is an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences Center in New Orleans, LA. She provides continuing nursing education to nurses across the Unites States, is active in several professional nursing organizations, and is intrigued by the many ways nurses use technology to communicate.
 
 
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