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Review
. 2024 Oct 18;31(10):6356-6383.
doi: 10.3390/curroncol31100473.

Managing Select Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitors

Parneet K Cheema  1 , Marco A J Iafolla  1 , Husam Abdel-Qadir  2   3 , Andrew B Bellini  1 , Nazira Chatur  4 , Natasha Chandok  1 , Vikram R Comondore  1 , Morven Cunningham  5 , Ilana Halperin  6 , Anne B Hu  1 , Diana Jaskolka  1 , Saeed Darvish-Kazem  1 , Masud H Khandaker  1 , Abhijat Kitchlu  7 , Jasdip S Sachdeva  1 , Shane Shapera  8 , Nicholas R J Woolnough  1 , Massey Nematollahi  1
Affiliations
Review

Managing Select Immune-Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitors

Parneet K Cheema et al. Curr Oncol. .

Abstract

The increased use of immune checkpoint inhibitors (ICIs) across cancer programs has created the need for standardized monitoring and management of immune-related adverse events (irAEs). Delayed recognition without appropriate treatment can have serious and life-threatening consequences. The management of irAEs presents a unique set of challenges that must be addressed at a multidisciplinary level. Although various national and international guidelines and working groups provide high-level recommendations for the management of irAEs, practical guidance is lacking. Furthermore, timely collaboration between specialists requires institutional protocols that enable the early recognition, assessment, and treatment of irAEs. Such protocols should be developed by institution specialists and include algorithms for all healthcare providers involved in the care of patients treated with ICIs. At William Osler Health System in Brampton, Ontario, practical step-by-step multidisciplinary treatment approaches with recommendations for the management of irAEs were developed in collaboration with experts across Canada. Here, we provide an in-depth description of the approaches, outlining baseline investigations prior to the initiation of ICIs, as well as the monitoring and management of irAEs based on symptoms, severity, and involved organ systems. We encourage other centres to adapt and modify our approaches according to their specific needs and requirements.

Keywords: immune checkpoint inhibitors; immune-related adverse events; immunosuppressants.

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Conflict of interest statement

P.K.C. has received honoraria and/or has participated in advisory board meetings with Amgen, AstraZeneca, Bristol-Myers-Squibb, Merck, Novartis, Pfizer, Roche, Janssen, and Sanofi and has received a research grant from AstraZeneca. M.A.J.I. has participated in advisory board meetings with Novartis and has received honoraria from Bayer, Canadian Urologic Association, CompassMD, Ipsen, MD Analytics, Merck, Save Your Skin, and Sermo Team and has conducted clinical research with Astellas Pharma Global Development Inc., AstraZeneca, and Bristol-Myers Squibb. A.B.B. has received honoraria and/or has participated in advisory board meetings with Pfizer, Janssen, Abbvie, Takeda, Celltrion, and JAMP. N.C. (Nazira Chatur) has received honoraria and/or has participated in advisory board meetings with Pfizer, AbbVie, Celltrion, Ferring, and Takeda. M.C. is on the speakers’ bureau for and received honoraria from Abbvie; she has also received honoraria from Janssen. I.H. has received consulting fees from Dexcom Canada, Abbott Diabetes Care, and Sanofi and has received honoraria from Novo Nordisk, Dexcom Canada, Tandem Diabetes Care, and Sanofi and was involved in the development of Diabetes Canada Guidelines. A.B.H. has received honoraria and/or has participated in advisory board meetings with AbbVie, Janssen, and Ferring. D.J. has received an honorarium for a presentation for Novo Nordisk and is a stockholder of Eli Lilly and Dexcom. M.H.K. has received honoraria from Pfizer. A.K. has received funding support from Amgen for a University Health Network Onco-Nephrology Fellowship and is Co-chair of the American Society of Onco-Nephrology Position Statement Committee. S.S. has received unrestricted educational grant funding from Boehringer Ingelheim and an honorarium for speaking at continuing medical education events from Astrazeneca Canada, Boehringer Ingelheim Canada, and Hoffman La-Roche Canada. H.A-Q., N.C. (Natasha Chandok), V.R.C., S.D-K., J.S.S., N.R.J.W. and M.N. declare no conflicts of interest.

Figures

Figure 1
Figure 1
Corticosteroids and immunosuppressants for the management of irAEs: general principles.
See this image and copyright information in PMC

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