Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

被引：1342

作者：

Schneider, Bryan J. ^{[1
]}

Naidoo, Jarushka ^{[2
,3
]}

Santomasso, Bianca D. ^{[4
]}

Lacchetti, Christina ^{[5
]}

Adkins, Sherry ^{[6
]}

Anadkat, Milan ^{[7
]}

Atkins, Michael B. ^{[8
]}

Brassil, Kelly J. ^{[6
]}

Caterino, Jeffrey M. ^{[9
]}

Chau, Ian ^{[10
,11
]}

Davies, Marianne J. ^{[12
,13
]}

Ernstoff, Marc S. ^{[14
]}

Fecher, Leslie ^{[1
]}

Ghosh, Monalisa ^{[15
]}

Jaiyesimi, Ishmael ^{[16
]}

Mammen, Jennifer S. ^{[17
]}

Naing, Aung ^{[6
]}

Nastoupil, Loretta J. ^{[6
]}

Phillips, Tanyanika ^{[18
]}

Porter, Laura D. ^{[19
]}

Reichner, Cristina A. ^{[20
]}

Seigel, Carole ^{[21
]}

Song, Jung-Min ^{[22
]}

Spira, Alexander ^{[23
]}

Suarez-Almazor, Maria ^{[6
]}

Swami, Umang ^{[24
]}

Thompson, John A. ^{[25
]}

Vikas, Praveen ^{[26
]}

Wang, Yinghong ^{[6
]}

Weber, Jeffrey S. ^{[27
]}

Funchain, Pauline ^{[22
]}

Bollin, Kathryn ^{[28
]}

机构：

[1] Univ Michigan Hlth Syst, Ann Arbor, MI USA

[2] Beaumont Hosp, Dublin, Ireland

[3] Sidney Kimmel Comprehens Canc Ctr, Baltimore, MD USA

[4] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA

[5] Amer Soc Clin Oncol, 2318 Mill Rd,Suite 800, Alexandria, VA 22314 USA

[6] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[7] Washington Univ, St Louis, MO 63110 USA

[8] Georgetown Lombardi Comprehens Canc Ctr, Washington, DC USA

[9] Ohio State Univ, Wexner Med Ctr, Columbus, OH 43210 USA

[10] Royal Marsden Hosp, Sutton, Surrey, England

[11] Inst Canc Res, Sutton, Surrey, England

[12] Smilow Canc Hosp, New Haven, CT USA

[13] Yale Sch Nursing, New Haven, CT USA

[14] NCI, Bethesda, MD 20892 USA

[15] Univ Michigan, Ann Arbor, MI 48109 USA

[16] Canc Care Associates PC, Royal Oak, MI USA

[17] Johns Hopkins Univ, Baltimore, MD USA

[18] City Hope Natl Med Ctr, Duarte, CA USA

[19] Colon Canc Alliance, Washington, DC USA

[20] Georgetown Univ, Washington, DC USA

[21] MGH Canc Ctr, Boston, MA USA

[22] Cleveland Clin, Cleveland, OH 44106 USA

[23] Virginia Canc Specialists & US Oncol, Fairfax, VA USA

[24] Univ Utah, Huntsman Canc Inst, Salt Lake City, UT USA

[25] Univ Washington Fred Hutchinson, Seattle Canc Care Alliance, Seattle, WA USA

[26] Univ Iowa, Iowa City, IA USA

[27] NYU, Langone Med Ctr, New York, NY USA

[28] Scripps MD Anderson Canc Ctr, San Diego, CA USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2021年 / 39卷 / 36期

关键词：

CLINICAL-PRACTICE GUIDELINE; LUNG-CANCER PATIENT; LONG-TERM SAFETY; CELL-DEATH; AMERICAN SOCIETY; ADVANCED MELANOMA; FECAL CALPROTECTIN; FULMINANT MYOCARDITIS; METASTATIC MELANOMA; TUMOR RESPONSE;

D O I：

10.1200/JCO.21.01440

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 [肿瘤学];

摘要：

PURPOSE To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert <= grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines. (C) 2021 by American Society of Clinical Oncology

引用

页码：4073 / +

页数：64

共 279 条

[1]

Risk of gastrointestinal complications in cancer patients treated with immune checkpoint inhibitors: a meta-analysis [J].