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

Authors

• I. Puzanov, Roswell Park Cancer Institute
• A. Diab, University of Texas MD Anderson Cancer Center
• K. Abdallah, Merck and Co., Inc.
• C. O. Bingham, Johns Hopkins University
• C. Brogdon, Bristol-Myers Squibb Company
• R. Dadu, University of Texas MD Anderson Cancer Center
• L. Hamad, Roswell Park Cancer Institute
• S. Kim, University of Texas MD Anderson Cancer Center
• M. E. Lacouture, Memorial Sloan Kettering Cancer Center
• N. R. LeBoeuf, Dana Farber/Brigham and Women's Cancer Center
• D. Lenihan, Washington University in St Louis
• C. Onofrei, Indiana University
• V. Shannon, University of Texas MD Anderson Cancer Center
• R. Sharma, Roswell Park Cancer Institute
• A. W. Silk, Massachusetts General Hospital
• D. Skondra, University of Chicago
• M. E. Suarez-Almazor, University of Texas MD Anderson Cancer Center
• Y. Wang, University of Texas MD Anderson Cancer Center
• K. Wiley, Oncology Nursing Society
• H. L. Kaufman, Massachusetts General Hospital
• M. S. Ernstoff, Roswell Park Cancer Institute
• J. Anderson, Bristol-Myers Squibb Company
• K. Lehman, Bristol-Myers Squibb Company
• D. Reshef, Bristol-Myers Squibb Company
• A. Saylors, Bristol-Myers Squibb Company
• M. Turner, Bristol-Myers Squibb Company
• I. Waxman, Bristol-Myers Squibb Company
• D. Arrindell, Amgen, Inc.
• S. Andrews, H. Lee Moffitt Cancer Center and Research Institute
• J. Ballesteros, Vivia Biotech S.L.
• J. Boyer, AstraZeneca
• I. Cotarla, AstraZeneca
• M. Dawson, AstraZeneca
• T. Goswami, AstraZeneca
• V. Hayreh, AstraZeneca
• W. Holmes, AstraZeneca
• Z. Rasheed, AstraZeneca
• M. Sarkeshik, AstraZeneca
• J. Schreiber, AstraZeneca
• K. Shafer-Weaver, AstraZeneca
• D. Chen, Genentech, Inc.
• S. Ley-Acosta, Genentech, Inc.
• D. Chonzi, Kite Pharma
• W. Go, Kite Pharma
• R. Cunha, National Cancer Institute
• J. L. Gulley, National Cancer Institute
• L. Wood, National Cancer Institute
• M. Davies, Yale Cancer Center
• Adam Dicker, Thomas Jefferson UniversityFollow
• L. Eifler, Prometheus Therapeutics and Diagnostics
• N. Gregory, Prometheus Therapeutics and Diagnostics
• A. Ferguson, Gritstone Oncology, Inc.
• C. Ferlini, F. Hoffmann La Roche Ltd.
• S. Frankel, Celgene Corporation
• C. Gochett, KentuckyOne Health
• J. Goldberg, Janssen Pharmaceuticals, Inc.
• K. Patel, Janssen Pharmaceuticals, Inc.
• D. Wariabharaj, Janssen Pharmaceuticals, Inc.
• P. Goncalves, National Cancer Institute, National Institutes of Health
• N. Helie, Johns Hopkins Department of Neurology and Neurosurgery Clinical Trials
• J. Y. Hsu, NGM Biopharmaceuticals, Inc.
• R. Ibrahim, Parker Institute for Cancer Immunotherapy
• C. Larocca, Dana Farber Cancer Institute, Brigham and Women's Hospital
• O. Lambotte, Assistance Publique Hôpitaux de Paris
• J. Luke, University of ChicagoFollow
• J. McClure, National Comprehensive Cancer Network
• E. Michelon, Pfizer Inc.
• M. Nakamura, University of California, San Francisco
• B. Piperdi, Merck and Co
• J. Riemer, Johns Hopkins Hospital
• C. Robert, Institut Gustave Roussy
• W. Sharfman, Johns Hopkins Medicine
• E. Sharon, Cancer Therapy Evaluation Program, National Cancer Institute
• R. Sherry, Center for Cancer Research, National Cancer Institute
• C. Simonson, (Un)Common Sense Solutions
• C. Thomas, Jounce Therapeutics, Inc.
• E. Trehu, Jounce Therapeutics, Inc.
• J. A. Thompson, University of Washington, Fred Hutchinson Cancer Research Center
• D. Tresnan, Pfizer Inc.
• L. Zhang, EMD Serono, Inc.
• P. Zheng, Children's National Medical Center

Document Type

Article

Publication Date

11-21-2017

Comments

This article has been peer reviewed. It is the author’s final published version in Journal for ImmunoTherapy of Cancer

Volume 5, Issue 1, November 2017, Article number 95

The published version is available at DOI: 10.1186/s40425-017-0300-z. Copyright © Puzanov et al.

Abstract

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.

Recommended Citation

Puzanov, I.; Diab, A.; Abdallah, K.; Bingham, C. O.; Brogdon, C.; Dadu, R.; Hamad, L.; Kim, S.; Lacouture, M. E.; LeBoeuf, N. R.; Lenihan, D.; Onofrei, C.; Shannon, V.; Sharma, R.; Silk, A. W.; Skondra, D.; Suarez-Almazor, M. E.; Wang, Y.; Wiley, K.; Kaufman, H. L.; Ernstoff, M. S.; Anderson, J.; Lehman, K.; Reshef, D.; Saylors, A.; Turner, M.; Waxman, I.; Arrindell, D.; Andrews, S.; Ballesteros, J.; Boyer, J.; Cotarla, I.; Dawson, M.; Goswami, T.; Hayreh, V.; Holmes, W.; Rasheed, Z.; Sarkeshik, M.; Schreiber, J.; Shafer-Weaver, K.; Chen, D.; Ley-Acosta, S.; Chonzi, D.; Go, W.; Cunha, R.; Gulley, J. L.; Wood, L.; Davies, M.; Dicker, Adam; Eifler, L.; Gregory, N.; Ferguson, A.; Ferlini, C.; Frankel, S.; Gochett, C.; Goldberg, J.; Patel, K.; Wariabharaj, D.; Goncalves, P.; Helie, N.; Hsu, J. Y.; Ibrahim, R.; Larocca, C.; Lambotte, O.; Luke, J.; McClure, J.; Michelon, E.; Nakamura, M.; Piperdi, B.; Riemer, J.; Robert, C.; Sharfman, W.; Sharon, E.; Sherry, R.; Simonson, C.; Thomas, C.; Trehu, E.; Thompson, J. A.; Tresnan, D.; Zhang, L.; and Zheng, P., "Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group." (2017). Department of Radiation Oncology Faculty Papers. Paper 99.
https://jdc.jefferson.edu/radoncfp/99

Creative Commons License

This work is licensed under a Creative Commons Public Domain Dedication 1.0 License.

PubMed ID

29162153