Eigentler, T.K., Hassel, J.C., Berking, C., Aberle, J., Bachmann, O., Grunwald, V., . . . Gutzmer, R. (2016). Diagnosis, monitoring and management of immune-related adverse drug reactions of anti-PD-1 antibody therapy. Cancer Treatment Reviews, 45, 7–18. 

DOI Link

Purpose & Patient Population

PURPOSE: Review article
 
TYPES OF PATIENTS ADDRESSED: Programmed cell death protein 1 (PD-1) immune checkpoint pathway inhibitors/antibody adverse events reported on patients treated with these agents while participating in registry clinical trials, a retrospective review, and a consensus panel of above authors.

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Expert opinion

PROCESS OF DEVELOPMENT: Review article
 
SEARCH STRATEGY:
  • DATABASES USED: None
  • INCLUSION CRITERIA: None
  • EXCLUSION CRITERIA: None

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

Review article

Guidelines & Recommendations

Skin events: Prevention and patient education. Topical glucocorticoids, urea-containing ointment, and oral antihistamines. Grade 3–4: hold checkpoint inhibitor, oral steroids with taper. 
 
GI events: Assess for progressive disease or infection. Grade 1: Antidiarrheal medications, oral hydration, and electrolyte supplementation. Grade 2 or higher: Colonoscopy with biopsy. Grade 2 persistent diarrhea: 0.5–1 mg/kg/day methylprednisolone or equivalent. For grade 3: 1–2 mg/kg/day methylprednisolone or equivalent administered. Taper steroids over four weeks. Immune therapy may be resumed after glucocorticoid taper. Grade 4: Permanently discontinue immune therapy.
 
Dyspnea: Tests include pulmonary function tests, chest X-ray, CT scan, and arterial blood gas. Treat with steroids based on grade. Grade 2: 1 mg/kg/day methylprednisolone or equivalent; grade 3–4: 2–4 mg/kg/day methylprednisolone or equivalent. Based on response to steroids, additional immune suppressant therapy may be needed.

Limitations

Literature review of common anti-PD-1 checkpoint pathway inhibitors/antibody therapy adverse events. No evidence of quality review provided.

Nursing Implications

Research is needed on the management of anti-PD-1 checkpoint pathway inhibitors/antibody therapy toxicities.