Latest NewsFDA NewsAdverse Event ManagementSupportive CareDisparities in Cancer CareDrug SafetyRadiation OncologySurvivorship Practice ManagementPreventionContributorsSponsored
Expert ConnectionsMorning RoundsThe VitalsPodcastsVideosBetween the LinesFrom All AnglesMeeting of the MindsTraining Academy
Conference CoverageConference Listing
Publications
Continuing Education
Case-Based Digest Rx Road MapWebinarsCancer Summary SlidesMPN Symptom ManagementEvents
SubscribePartners
Brain Cancer
Breast CancerBreast Cancer
Gastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal Cancer
Genitourinary CancerGenitourinary CancerGenitourinary CancerGenitourinary Cancer
Gynecologic CancersGynecologic CancersGynecologic CancersGynecologic Cancers
Head and Neck Cancers
HematologyHematologyHematologyHematologyHematologyHematology
Lung Cancer
Pediatric Cancer
Sarcomas
Skin CancerSkin Cancer
Advanced Practice Corner Logo
    Brain Cancer
    Breast CancerBreast Cancer
    Gastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal Cancer
    Genitourinary CancerGenitourinary CancerGenitourinary CancerGenitourinary Cancer
    Gynecologic CancersGynecologic CancersGynecologic CancersGynecologic Cancers
    Head and Neck Cancers
    HematologyHematologyHematologyHematologyHematologyHematology
    Lung Cancer
    Pediatric Cancer
    Sarcomas
    Skin CancerSkin Cancer
    Advanced Practice Corner Logo
        • Publications
        • Subscribe
        • Partners
      Advertisement

      Immunotherapy Related AEs Are Manageable with Nurse Intervention

      August 16, 2021
      By Lindsay Fischer
      Article
      Conferences|Annual School of Nursing Oncology

      “If you're an oncology nurse, you will have patients with immunotherapy–which is why we want to make sure that we are really familiar with these side effects.”

      Oncology nurses taking care of patients treated with immunotherapy can ensure they continue to receive this therapy and lower hospitalizations by remaining diligent in suspecting and detecting immune-related adverse events (irAEs), said Grace Cherry, RN, MS, NP, UCLA melanoma program, during a presentation at the 5th Annual School of Nursing Oncology meeting.

      “If you're an oncology nurse, you will have patients with immunotherapy–which is why we want to make sure that we are really familiar with these side effects,” Cherry emphasized.

      Immune Related Adverse Events

      IrAEs are currently unpredictable. They can appear at any time, in any organ or tissue. There are currently no markers to indicate which patients will have a reaction, although it is suspected that those who are autoimmune are at greater risk.

      Common irAEs include fatigue, dermatitis, colitis, endocrinopathies, hepatitis, and pneumonitis. However, there are also rare irAEs that can occur, such as neurological, hematological, cardiac, musculoskeletal, and renal symptoms. Cherry urges oncology nurses to always “be suspicious.”

      “I would like to invite for you to be that person who will be suspicious. Be that person who will [ask]: Is this an immune related adverse event?” encouraged Cherry. “And report it… because if it is [an irAE] we can treat them with prednisone, and the expectation is that it will get better.”

      The Principles of Management

      The primary principle of irAE management is early diagnosis. For this to be possible, patients must be taught to communicate any change they experience.

      “Communication, communication, communication,” stressed Cherry. “We have to let them know how to communicate to us if they're having symptoms. Do they know who to call? Do they have a phone number? Do they know to call on the weekend if they’re having a cough or profuse diarrhea?

      The second step is to rule out other causes. IrAEs are unpredictable and difficult to diagnose, so Cherry advises involving other specialists with different instruments and training whenever possible. For example, if a patient experiences blurry vision, it is important to call an ophthalmologist, because they can look inside the eyeballs and provide a truly thorough evaluation.Using an interdisciplinary team is often the best way to receive early and accurate diagnoses.

      Cherry also emphasized the importance of understanding common terminology criteria for adverse event (CTCAE) because it provides clinicians with a common language. Generally, immunotherapy can be continued with frequent monitoring as long as the AE is grade 1.

      Grade 2 indicates that immunotherapy should be held, and symptoms managed. If symptoms are improved to grade 1, the therapy can continue. Glucocorticosteroids are recommended at 0.5–mg/kg per day if symptoms persist beyond 5 to 7 days.

      If symptoms are not improved with use of steroids and worsen to a grade 3, not only should immunotherapy be held, but the glucocorticosteroids dosage should be increased to 1 to 2 mg/kg per day and hospitalization should be considered.

      If the irAE reaches grade 4, therapy should be discontinued, and the patient should receive urgent intervention.

      Managing Immune Related Adverse Events

      There are currently 7 FDA approved immunotherapies. Anti-PD-1 therapies such as nivolumab (Opdivo), pembrolizumab (Keytruda), and cemiplimab (Libtayo), are generally much better tolerated than anti-PD-L1 drugs like atezolizumab (Tecentriq), avelumab (Bavencio), and durvalumab (Imfinzi), or the anti-ctla-4 therapy, ipilimumab (Yervoy).

      The standard treatment for irAE is systemic steroids therapy; 0.5 to 2 mg/kg/d of prednisone or equivalent should be administered in either IV or oral form, depending on the severity, and should be tapered gradually over the next 4 to 6 weeks. Various literature suggests that the use of steroids does not impact the efficacy of the immunotherapy, said Cherry.

      If steroid therapy does not induce a positive response within 2 to 3 days, the next step is usually an immunosuppressant. Guidelines recommend infliximab for colitis, mycophenolate for hepatitis, and an antifungal prophylaxis for pneumocystis.

      Prednisone can affect glucose levels, so blood sugar should be monitored when administering that steroid. In addition, PP1 and H2 blockers are recommended to prevent gastritis, while vitamin-d and calcium are encouraged to prevent osteoporosis.

      Cherry reminded nurses that irAEs are treatable. She recounted how gratifying it feels as an oncology nurse to successfully catch and manage an irAE and allow a patient to continue treatment.

      As an example, she recalled a patient who was successfully treated for their adrenal insufficiency with 20mg hydrocortisone twice a day and was consequently able to continue their monthly monotherapy of nivolumab.

      “I have to say personally, it's really gratifying when we catch patients with adrenal insufficiency, because.. they look so sick, and they feel horrible, but when we properly diagnose, and give the supplement of hydrocortisone, symptoms immediately get better. So, it's really, really gratifying. But even more gratifying than that is they continue to take therapy that is lifesaving.”

      Patient Considerations

      Some patients receiving immunotherapy are apprehensive to receive the COVID-19 vaccine. However, the NCCN has stated that patients with cancer respond well to messenger RNA SARS-CoV-2 vaccines and should continue to be prioritized for immunizations. Exceptions include patients who have received stem call transplant, cellular therapy, major surgery or have acute leukemia.

      Both the NCCN and the Society of Immunotherapy of Cancer have patient geared resources for understanding immunotherapy. Furthermore, both the NCCN and ASCO release regularly updated immunotherapy management guidelines for clinicians.

      Cherry also urges that patients use immunotherapy wallet cards and that families and caregivers be incorporated in the symptom management process. Any change from baseline should be reported right away.

      “Communication is the key. Communication with patients. Communication with other health care providers. Early reporting is so important, make sure your patients know who to call, how to call, how to report symptoms. Let them know what their baseline is. If it's anything different, report it to us. Our job is to figure out is this immune related or not… So, we continue to give these treatments safely, so that our patients can continue with their life saving treatments.”

      Reference

      Cherry G. Management of Immune Related Adverse Events (irAE). Presented at: 5th Annual School of Nursing Oncology; August 6-7, 2021; Virtual.

      Newsletter

      Stay up to date on recent advances in oncology nursing and patient care.

      Subscribe Now!
      Recent Videos
      Photo of a woman wearing a blazer and a colorful scarf in front of a blue background
      Photo of a man wearing a suit with a blue tie in front of a dark blue background
      Photo of a man wearing glasses and a suit in front of a blue background
      Photo of a man wearing a suit with a blue tie in front of a dark blue background
      Photo of Hope Rugo, MD
      Image of a woman with blond hair in front of a dark blue background
      Image of a man in a suit smiling in front of an Oncology Nursing News background
      Photo of a woman wearing a blazer in front of an Oncology Nursing News backdrop
      Photo of a white man with curly hair and in front of a blue Oncology Nursing News backdrop
      Image of a woman with gray hair and glasses in front of a blue Oncology Nursing News background
      Related Content

      Graphic of malignant B cells

      Sonrotoclax/Zanubrutinib Generates Durable Response in R/R MCL

      Chris Ryan
      July 30th 2025
      Article

      Adding sonrotoclax to zanubrutinib led to deep and durable response in relapsed or refractory mantle cell lymphoma, according to EHA Congress data.


      The Vitals

      Nicole Gay Shares How She Counsels Patients on Lung Cancer Screenings

      Lindsay Fischer
      November 15th 2023
      Podcast

      Nicole Gay, APRN-C, shares how nurse navigators can talk to their patients about lung cancer screening.


      Line illustration of a pair of kidneys with a tumor on the left kidney

      Belzutifan May Lengthen Quality-Adjusted Survival in Advanced RCC

      Russ Conroy
      July 21st 2025
      Article

      A quality-adjusted time without symptoms or toxicity analysis identified better outcomes for patients with RCC treated with belzutifan vs everolimus.


      Improving The Rate Of Accurate Inflammatory Breast Cancer Diagnoses

      Improving The Rate Of Accurate Inflammatory Breast Cancer Diagnoses

      Lindsay Fischer
      October 2nd 2023
      Podcast

      Ryan Tamargo, NP, AONCP, discusses the launch of an online inflammatory breast cancer scoring system tool.


      Graphic of a kidney

      Neoantigen Vaccine Shows Promise in Mutated Renal Cell Carcinoma

      Ashling Wahner
      July 18th 2025
      Article

      A personalized neoantigen vaccine may be effective in patients with clear cell renal cell carcinoma, shared David A. Braun, MD, PhD.


      Graphic of a breast with a tumor

      Real-World Data Tie Early Breast Cancer ctDNA to Recurrence, Lower OS

      Jax DiEugenio
      July 14th 2025
      Article

      Data from a research database link ctDNA positivity in early breast cancer with poorer survival and higher recurrence risk.

      Related Content

      Graphic of malignant B cells

      Sonrotoclax/Zanubrutinib Generates Durable Response in R/R MCL

      Chris Ryan
      July 30th 2025
      Article

      Adding sonrotoclax to zanubrutinib led to deep and durable response in relapsed or refractory mantle cell lymphoma, according to EHA Congress data.


      The Vitals

      Nicole Gay Shares How She Counsels Patients on Lung Cancer Screenings

      Lindsay Fischer
      November 15th 2023
      Podcast

      Nicole Gay, APRN-C, shares how nurse navigators can talk to their patients about lung cancer screening.


      Line illustration of a pair of kidneys with a tumor on the left kidney

      Belzutifan May Lengthen Quality-Adjusted Survival in Advanced RCC

      Russ Conroy
      July 21st 2025
      Article

      A quality-adjusted time without symptoms or toxicity analysis identified better outcomes for patients with RCC treated with belzutifan vs everolimus.


      Improving The Rate Of Accurate Inflammatory Breast Cancer Diagnoses

      Improving The Rate Of Accurate Inflammatory Breast Cancer Diagnoses

      Lindsay Fischer
      October 2nd 2023
      Podcast

      Ryan Tamargo, NP, AONCP, discusses the launch of an online inflammatory breast cancer scoring system tool.


      Graphic of a kidney

      Neoantigen Vaccine Shows Promise in Mutated Renal Cell Carcinoma

      Ashling Wahner
      July 18th 2025
      Article

      A personalized neoantigen vaccine may be effective in patients with clear cell renal cell carcinoma, shared David A. Braun, MD, PhD.


      Graphic of a breast with a tumor

      Real-World Data Tie Early Breast Cancer ctDNA to Recurrence, Lower OS

      Jax DiEugenio
      July 14th 2025
      Article

      Data from a research database link ctDNA positivity in early breast cancer with poorer survival and higher recurrence risk.

      Latest Conference Coverage

      Sonrotoclax/Zanubrutinib Generates Durable Response in R/R MCL

      Q&A: Nursing Considerations From Immune Cell Effector Therapy Experts

      Proactive Rash Management Vital for PI3K, AKT Inhibition in Breast Cancer

      Understanding How On-Target and Off-Target ADC Toxicities Work

      View More Latest Conference Coverage
      About Us
      Editorial Board
      Contact Us
      CancerNetwork.com
      CureToday.com
      OncLive.com
      TargetedOnc.com
      Advertise
      Privacy
      Terms & Conditions
      Do Not Sell My Information
      Contact Info

      2 Commerce Drive
      Cranbury, NJ 08512

      609-716-7777

      © 2025 MJH Life Sciences

      All rights reserved.