Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group

Cancer immunotherapy has transformed the treatment of cancer. However, increasing use of immune-based therapies, including the widely used class of agents known as immune checkpoint inhibitors, has exposed a discrete group of immune-related adverse events (irAEs). Many of these are driven by the same immunologic mechanisms responsible for the drugs' therapeutic effects, namely blockade of inhibitory mechanisms that suppress the immune system and protect body tissues from an unconstrained acute or chronic immune response. Skin, gut, endocrine, lung and musculoskeletal irAEs are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently. The majority of irAEs are mild to moderate in severity; however, serious and occasionally life-threatening irAEs are reported in the literature, and treatment-related deaths occur in up to 2% of patients, varying by ICI. Immunotherapy-related irAEs typically have a delayed onset and prolonged duration compared to adverse events from chemotherapy, and effective management depends on early recognition and prompt intervention with immune suppression and/or immunomodulatory strategies. There is an urgent need for multidisciplinary guidance reflecting broad-based perspectives on how to recognize, report and manage organ-specific toxicities until evidence-based data are available to inform clinical decision-making. The Society for Immunotherapy of Cancer (SITC) established a multidisciplinary Toxicity Management Working Group, which met for a full-day workshop to develop recommendations to standardize management of irAEs. Here we present their consensus recommendations on managing toxicities associated with immune checkpoint inhibitor therapy.

Journal for immunotherapy of cancer. 2017 Nov 21*** epublish ***

I Puzanov, A Diab, K Abdallah, C O Bingham, C Brogdon, R Dadu, L Hamad, S Kim, M E Lacouture, N R LeBoeuf, D Lenihan, C Onofrei, V Shannon, R Sharma, A W Silk, D Skondra, M E Suarez-Almazor, Y Wang, K Wiley, H L Kaufman, M S Ernstoff, Society for Immunotherapy of Cancer Toxicity Management Working Group

Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA., University of Texas MD Anderson Cancer Center, Houston, TX, USA., Merck & Co., Inc., Upper Gwynedd, PA, USA., Johns Hopkins University, Baltimore, MD, USA., Bristol-Myers Squibb Company, New York, NY, USA., Memorial Sloan Kettering Cancer Center, New York, NY, USA., Dana Farber/Brigham and Women's Cancer Center, Boston, MA, USA., Washington University in St Louis, St Louis, MO, USA., Indiana University, Indianapolis, IN, USA., Massachusetts General Hospital, Boston, MA, USA., University of Chicago, Chicago, IL, USA., Oncology Nursing Society, Pittsburgh, PA, USA., Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA. .