medwireNews: ASCO has released updated guidelines for the management of immune-related adverse events (irAEs) in people with cancer receiving immune checkpoint inhibitors (ICIs).
The document was developed by a multidisciplinary panel of experts – including medical oncologists, hematologists, endocrinologists, neurologists, nurses, patient advocates, and others – and comprises consensus-based recommendations of moderate strength. The guidelines are based on a systematic review focusing on publications between 2017 and 2021, and update the version issued in 2018 by the society.
Writing in the Journal of Clinical Oncology, the guideline authors say: “With the increasing use of immunotherapy in cancer treatment regimens, it is imperative that clinicians be knowledgeable about the symptoms associated with these agents, how best to monitor them, and their recommended management.”
In addition to recommendations for the management of organ-specific and systemic irAEs, they also provide “general recommendations that should be followed irrespective of affected organs,” including guidance by grade:
- Grade 1 – ICI therapy can be continued with close monitoring, except in the case of some neurologic, hematologic, and cardiologic toxicities;
- Grade 2 – Consider suspending ICIs, with the option to resume once symptoms resolve to grade 1 or below;
- Grade 3 – ICIs should be suspended and high-dose corticosteroids initiated, with rechallenge possible with caution;
- Grade 4 – Such toxicities warrant permanent discontinuation, except in the case of endocrinopathies that are controlled by hormone replacement.
The clinical practice guidelines also include a section on special considerations during the ongoing COVID-19 pandemic, touching on topics such as the differential diagnosis of irAEs versus COVID-19 and vaccination.
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