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Review
. 2017 Jan-Feb;8(1):58-72.
doi: 10.6004/jadpro.2017.8.1.5. Epub 2017 Jan 1.

Understanding and Managing Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Patients With Advanced Melanoma

Alyona Weinstein  1 , Ruth-Ann Gordon  1 , Mary Kate Kasler  1 , Matthew Burke  2 , Smita Ranjan  3 , Jackie Hodgetts  4 , Vanessa Reed  1 , Yelena Shames  1 , Nana Prempeh-Keteku  1 , Karla Lingard  5
Affiliations
Review

Understanding and Managing Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Patients With Advanced Melanoma

Alyona Weinstein et al. J Adv Pract Oncol. 2017 Jan-Feb.

Abstract

The immune checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab represent a substantial improvement in treating advanced melanoma but are associated with adverse events (AEs) likely related to general immunologic enhancement. To ensure that patients receive optimal benefit from these agents, prompt assessment and treatment of AEs are essential. We review the efficacy and safety profiles of these immune checkpoint inhibitors and describe guidelines for managing immune-related AEs. We also present case studies describing the management of toxicities in patients receiving immune checkpoint inhibitor therapy. These cases illustrate the importance of collecting a detailed medical history when administering immunotherapy, as this information is necessary to establish baseline, inform monitoring, and determine the etiology of symptoms. Advanced practice nurses and physician assistants are uniquely positioned to educate patients on the early recognition of AEs and have an important role in establishing appropriate monitoring and open dialogue among services.

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Figures

Figure
Figure
Immune checkpoint inhibition of CTLA-4 or PD-1 pathways by antitumor immunotherapy. CTLA- 4 = cytotoxic T-lymphocyte–associated protein 4; PD-1 = programmed cell death protein 1; MHC = major histocompatibility complex; TCR = T-cell receptor; PD-L1 = programmed cell death ligand 1. Adapted from Rothschild et al. (2015) with permission from EMH Swiss Medical Publishers Ltd.
Table 1
Table 1
Key Efficacy Data in Advanced Melanoma for Immune Checkpoint Inhibitor Therapy
Table 2
Table 2
Immune-Related Adverse Events in Key Registrational Trials
Table 3
Table 3
Timing of Immune-Related Adverse Events
Table 4
Table 4
Identification of Dermatologic, Gastrointestinal, and Endocrine irAEs
Appendix A
Appendix A
Appendix A Grading of irAEs: Common Terminology Criteria for Adverse Events for Dermatologic, Gastrointestinal, and Endocrine irAEs
Appendix B
Appendix B
Appendix B Management of Dermatologic, Gastrointestinal, and Endocrine irAEs
Appendix B
Appendix B
Appendix B Management of Dermatologic, Gastrointestinal, and Endocrine irAEs (cont.)
Appendix C
Appendix C
Appendix C Nurse’s Checklist for Immune Checkpoint Inhibitor Therapy
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References

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