Steroids are a type of compound that contains a characteristic chemical structure. Steroid drugs have anti-inflammatory activity. Systemic steroids have been used for the treatment of pneumonitis associated with immunotherapies. New onset or worsening dyspnea in patients receiving immunotherapy may indicate pneumonitis.
Dadu, R., Zobniw, C., & Diab, A. (2016). Managing adverse events with immune checkpoint agents. Cancer Journal, 22, 121–129.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Expert opinion
Literature review of common checkpoint inhibitors adverse events. No quality review provided.
Further education needs to be available on the toxicity profile related to immune checkpoint inhibitors, and obtaining a detailed personal and family history of autoimmune diseases, other comorbidies, concurrent medications, PE, and medications of patients is important prior to starting therapy.
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.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Review article
Literature review of common anti-PD-1 checkpoint pathway inhibitors/antibody therapy adverse events. No evidence of quality review provided.
Research is needed on the management of anti-PD-1 checkpoint pathway inhibitors/antibody therapy toxicities.
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.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Review article
Literature review of common checkpoint inhibitor adverse and serious adverse events. No evidence quality review was provided.
Research is needed on the management of checkpoint inhibitor therapy toxicities.
Howell, M., Lee, R., Bowyer, S., Fusi, A., & Lorigan, P. (2015). Optimal management of immune-related toxicities associated with checkpoint inhibitors in lung cancer. Lung Cancer, 88, 117–123.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Briefly reviews the management of diarrhea related to checkpoint inhibitor adverse reactions.
Brief literature review of common checkpoint inhibitor adverse and serious adverse events. No evidence quality review was provided.
Patient education is crucial to the early reporting of adverse events that develop in patients after treatment with checkpoint inhibitors. Closely monitor patients with evidence of adverse events. Hospitalization and aggressive patient support may be required for serious adverse events.
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.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Expert opinion level information
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.
Villadolid, J., & Amin, A. (2015). Immune checkpoint inhibitors in clinical practice: Update on management of immune-related toxicities. Translational Lung Cancer Research, 4, 560–575.
RESOURCE TYPE: Expert opinion
PROCESS OF DEVELOPMENT: Review of clinical trials results and clinical experience
Currently, limited evidence regarding the effects of interventions for adverse events with immunotherapy exists, and current information is based on initial clinical trial results and personal clinical experience.
Nurses need to be aware of the myriad adverse effects that can occur with immunotherapies, and recognize that many of them can occur long after treatment has concluded. This means that patient teaching and ongoing follow-up to assess for these effects are crucial. Current sources point to the importance of early detection and interventions for the management of adverse effects to prevent more severe negative patient outcomes. As opposed to some other sources, these authors recommend against “knee jerk” implementation of systemic corticosteroids for diarrhea because such treatment may mask the development of severe colitis.