Naidoo, J., Page, D.B., Li, B.T., Connell, L.C., Schindler, K., Lacouture, M.E., . . . Wolchok, J.D. (2016). Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Annals of Oncology, 27, 1362.
DOI Link
Purpose & Patient Population
PURPOSE: To review the clinical studies and summarize adverse events and management algorithms
TYPES OF PATIENTS ADDRESSED: Patients receiving checkpoint inhibitor therapy
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Expert opinion
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Guidelines & Recommendations
Skin rash: For grade 1, use topical corticosteroids and oral antihistamines for pruritis. For grade 2, use oral prednisone and antihistamines. For grade 3–4, hold immunotherapy and use oral steroids and antihistamines. If symptoms worsen in 48 hours, consider infliximab, cyclophosphamide, or mycophenolate mofetil.
Diarrhea: For grade 1, use lomotil. For worsening diarrhea, use oral corticosteroids. If diarrhea persists or worsens, use IV steroids, and if still unresolved, consider infliximab.
Dysypnea: For new symptoms, withhold immunotherapy and oral prednisone. For grade 3–4 pneumonitis, discontinue immunotherapy, IV corticosteroids, and prophylactic antibiotics. If it worsens in 48 hours, consider infliximab, cyclophosphamide, or mycophenolate mofetil.
Limitations
Expert opinion level information
Nursing Implications
Nurses need to be aware of potential immune-related adverse events and current recommendations for management. Although some differences in opinion exist, overall management involves the use of systemic steroids for moderate symptoms, aggressive use of IV steroids for more severe symptoms, and consideration of immunosuppression for persistent or worsening severe symptoms.