Fay, A.P., Moreira, R.B., Nunes Filho, P.R., Albuquerque, C., & Barrios, C.H. (2016). The management of immune-related adverse events associated with immune checkpoint blockade. Expert Review of Quality of Life in Cancer Care, 1, 89–97. 

PURPOSE: To review article

 

TYPES OF PATIENTS ADDRESSED: Immune checkpoint blockade therapy

PROCESS OF DEVELOPMENT: Review article

 

DATABASES USED: None

 

INCLUSION CRITERIA: None

 

EXCLUSION CRITERIA: None

General guidelines: Grade 2: Treatment break until toxicity is grade 1 or less, prednisone 0.5 mg/kg/day or equivalent start if no improvement in symptoms occur after a few days. Grade 3–4: Prednisone 1–2 mg/kg/day or equivalent; after toxicity is grade 1, taper steroid over a few weeks. Immune therapy may need to be discontinued.

 

Rash: Topical steroids, such as betamethasone 0.1% or clobetasol 0.05%. Grade 2: Topical or oral steroids, such as prednisone, dosed up to 0.5 mg/kg/day or equivalent. Grade 3: IV methylprednisolone 1–2 mg/kg/day or equivalent. When rash improves, switch to oral therapy and taper carefully.

 

Diarrhea: Grade 1–2: Antidiarrheal agents, oral hydration and electrolytes, diet changes, and antimotility agents. Persisting Grade 2 diarrhea: 4–6 stool/day for more than three days; steroid 0.5 mg/kg/day prednisolone or equivalent; with improvement in diarrhea, taper steroids over four weeks. Grade 3–4: Seven stools/day or more; colonoscopy or CT abdomen; stool for leucocytes and culture; IV fluids; and IV steroids, such as methylprednisolone, 125 mg followed by oral steroids prednisone 1–2 mg/kg or equivalent. Infliximab 5 mg/kg every two weeks if colitis does not improve in 2–3 days. Taper steroids over 6–8 weeks after improvement.  

 

Dyspnea—severe toxicity: 1–2 mg/kg IV steroid; if no improvement, infliximab or other immune-suppressant agents may be used.