Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

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 .

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Affiliated Institutions

• Virginia Cancer Specialists US
• Royal Marsden Hospital GB
• University of Utah US
• Huntsman Cancer Institute US
• Institute of Cancer Research GB
• Breast Cancer Alliance US
• Georgetown Lombardi Comprehensive Cancer Center
• National Cancer Institute US
• Sidney Kimmel Comprehensive Cancer Center US
• Scripps MD Anderson Cancer Center US
• The University of Texas MD Anderson Cancer Center US
• Royal Marsden NHS Foundation Trust GB
• Seattle Cancer Care Alliance US
• Michigan Medicine US
• American Society of Clinical Oncology US
• Smilow Cancer Hospital US
• Cleveland Clinic US
• City of Hope US
• Beaumont Hospital IE
• Colorectal Cancer Alliance
• University of Iowa US
• Fred Hutch Cancer Center US
• The Ohio State University Wexner Medical Center US
• NYU Langone Health US
• University of Michigan US
• Georgetown University US
• Johns Hopkins University US
• University of Washington US
• Memorial Sloan Kettering Cancer Center US
• Washington University in St. Louis US

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