Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline

被引：3021

作者：

Brahmer, Julie R. ^{[1
]}

Lacchetti, Christina ^{[3
]}

Schneider, Bryan J. ^{[6
]}

Atkins, Michael B. ^{[7
]}

Brassil, Kelly J. ^{[10
]}

Caterino, Jeffrey M. ^{[11
]}

Chau, Ian ^{[12
,13
,14
,15
]}

Ernstoff, Marc S. ^{[16
]}

Gardner, Jennifer M. ^{[20
,21
]}

Ginex, Pamela ^{[19
]}

Hallmeyer, Sigrun ^{[22
]}

Chakrabarty, Jennifer Holter ^{[23
]}

Leighl, Natasha B. ^{[24
]}

Mammen, Jennifer S. ^{[2
]}

McDermott, David F. ^{[25
]}

Naing, Aung ^{[10
]}

Nastoupil, Loretta J. ^{[10
]}

Phillips, Tanyanika ^{[29
]}

Porter, Laura D. ^{[9
]}

Puzanov, Igor ^{[16
]}

Reichner, Cristina A. ^{[8
]}

Santomasso, Bianca D. ^{[17
]}

Seigel, Carole ^{[26
]}

Spira, Alexander ^{[4
,5
]}

Suarez-Almazor, Maria E. ^{[10
]}

Wang, Yinghong ^{[10
]}

Weber, Jeffrey S. ^{[18
]}

Wolchok, Jedd D. ^{[17
]}

Thompson, John A. ^{[27
,28
]}

机构：

[1] Johns Hopkins Kimmel Canc Ctr, Baltimore, MD USA

[2] Johns Hopkins Univ, Baltimore, MD USA

[3] Amer Soc Clin Oncol, 2318 Mill Rd,Ste 800, Alexandria, VA 22314 USA

[4] Virginia Canc Specialists, Fairfax, VA USA

[5] US Oncol Res, Fairfax, VA USA

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

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

[8] Georgetown Univ, Washington, DC USA

[9] Colon Canc Alliance, Washington, DC USA

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

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

[12] Royal Marsden Hosp, London, England

[13] Inst Canc Res, London, England

[14] Royal Marsden Hosp, Surrey, England

[15] Inst Canc Res, Surrey, England

[16] Roswell Pk Canc Inst, Buffalo, NY 14263 USA

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

[18] NYU, LangoneMed Ctr, New York, NY USA

[19] Oncol Nursing Soc, Pittsburgh, PA USA

[20] Seattle Canc Care Alliance, Seattle, WA USA

[21] Univ Washington, Seattle, WA 98195 USA

[22] Oncol Specialists SC, Park Ridge, IL USA

[23] Univ Oklahoma, Stephenson Canc Ctr, Oklahoma City, OK USA

[24] Princess Margaret Canc Ctr, Toronto, ON, Canada

[25] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[26] Massachusetts Gen Hosp, Ctr Canc, Boston, MA USA

[27] Univ Washington, Seattle Canc Care Alliance, Seattle, WA 98195 USA

[28] Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA

[29] CHRISTUS St Frances Cabrini Canc Ctr, Alexandria, LA USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2018年 / 36卷 / 17期

关键词：

PROGRAMMED DEATH 1; LONG-TERM SAFETY; ADVANCED MELANOMA; METASTATIC MELANOMA; FULMINANT MYOCARDITIS; CANCER-PATIENTS; OPEN-LABEL; INFLAMMATORY ARTHRITIS; COMBINATION IPILIMUMAB; NIVOLUMAB MONOTHERAPY;

D O I：

10.1200/JCO.2017.77.6385

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 in patients treated with immune checkpoint inhibitor (ICPi) therapy. Methods A multidisciplinary, multi-organizational panel of experts in medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, urology, neurology, hematology, emergency medicine, nursing, trialist, and advocacy was convened to develop the clinical practice guideline. Guideline development involved a systematic review of the literature and an informal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, randomized controlled trials, and case series published from 2000 through 2017. Results The systematic review identified 204 eligible publications. Much of the evidence consisted of systematic reviews of observational data, consensus guidelines, case series, and case reports. Due to the paucity of high-quality evidence on management of immune-related adverse events, recommendations are based on expert consensus. Recommendations Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, with the exception of some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert to grade 1 or less. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids (prednisone 1 to 2 mg/kg/d or methylprednisolone 1 to 2 mg/kg/d). Corticosteroids should be tapered over the course of at least 4 to 6 weeks. Some refractory cases may require infliximab or other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, with the exception of endocrinopathies that have been controlled by hormone replacement. (C) 2018 American Society of Clinical Oncology and National Comprehensive Cancer Network.

引用

页码：1714 / +

页数：60

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