Introduction to Diagnosing and Managing Immune-mediated Adverse Events (imAEs)
Immuno-oncology (IO) treatments are now considered standard therapy options for many types of cancer. However, along with checkpoint inhibition, comes a unique set of possible side effects termed imAEs.1,2
“As immuno-oncology treatments multiply, one challenge for physicians is learning to recognize and manage unique immune-mediated adverse events.” —Dr Antonia
Watch Scott Antonia, MD, PhD, medical oncologist and Chair of the Thoracic Oncology Department at the Moffitt Cancer Center in Tampa, Florida give a brief introduction to imAEs in immuno-oncology.
Since imAEs can be different from what is expected with chemotherapy, it’s important to understand the safety profile of the specific treatment and encourage your patients to track any symptoms they may experience.2,6
The organs most commonly affected by imAEs are skin, liver (hepatitis), kidneys (nephritis), gastrointestinal tract (diarrhea and colitis), lungs (pneumonitis), and endocrine organs (hyperthyroidism, hypothyroidism, and hypophysitis). However, imAEs can affect any organ or tissue.2,6,7
If left untreated, imAEs could progress to become harmful or life-threatening conditions.5,6
Educate your patients. Make sure they1,6:
- Understand imAE symptoms to look for
- Immediately report unusual signs and symptoms
- Go directly to the oncologist’s office for symptom evaluation and/or treatment
Monitor your patients’ health4-6:
- Schedule blood testing (CBC, renal, hepatic, pancreatic, thyroid)
- Schedule patients for regular visits for blood and symptom monitoring
- Encourage patients to track their symptoms
Although regular diagnostic workups include routine laboratory tests, in cases of pneumonitis or hypophysitis, imaging (high-resolution CT, MRI, or radiography) can confirm diagnosis.1,5
Early recognition and monitoring of all imAEs can help manage adverse events before they become more serious and cause treatment interruption.5,6
Create an action plan2,6
- Follow a clear management algorithm for all grades of toxicities
- Understand when a specialist should be contacted to help manage imAEs
Intervene when necessary5
- Take immediate action, even for Grade 1 toxicities
- Hold dosing until symptoms resolve
- Start with OTC medications, initiate steroids early if needed
In general, the management of imAEs may include the use of corticosteroids or other immunosuppressive agents. Consult applicable product label for specific recommendations.3,5
Watch the videos below to learn more about the diagnosis and treatment of imAEs related to the most commonly affected organs.
“Patients should be counseled, educated on those sorts of symptoms to look out for and report, because those symptoms may occur before we as treating physicians are aware of it based on blood abnormalities.” —Dr Antonia
imAEs: Endocrine System
Watch Scott Antonia, MD, PhD, medical oncologist and Chair of the Thoracic Oncology Department at the Moffitt Cancer Center in Tampa, Florida, discuss the diagnosis and treatment of hyperthyroidism, hypothyroidism, hypophysitis, and related imAEs.
“The activation of the immune system can generate a number of so-called immune-related adverse events. And I would say the most common one is colitis.” —Dr Maio
imAEs: Gastrointestinal Tract
Watch Michele Maio, MD, PhD, Director of the division of Medical Oncology and Immunotherapy at the University Hospital of Siena, Italy, discuss the diagnosis and treatment of diarrhea, colitis, and related imAEs.
“Immune-related nephritis is, luckily, a fairly rare scenario. It occurs well under 1% of the time.” —Dr Weber
Watch Jeffrey Weber, MD, PhD, medical oncologist and Deputy Director at the Perlmutter Cancer Center at the NYU Langone Medical Center in New York, discuss the diagnosis and treatment of nephritis and related imAEs.
“Hepatitis is almost always asymptomatic and that is why we always incorporate blood tests and liver function tests into our workups.” —Dr Antonia
Watch Scott Antonia, MD, PhD, medical oncologist and Chair of the Thoracic Oncology Department at the Moffitt Cancer Center in Tampa, Florida, discuss the diagnosis and treatment of hepatitis and related imAEs.
“If we intervene early with steroids we often, and rarely, I would say, need to go to the next step that is higher-dose steroids with longer taper.” —Dr Cohen
Watch Ezra Cohen, MD, medical oncologist at the UC San Diego Moores Cancer Center, discuss the diagnosis and treatment of pneumonitis and related imAEs.
“What we tell patients about skin reactions is that this tends to be one of the earlier side effects they may notice.” —Dr Cohen
Watch Ezra Cohen, MD, medical oncologist at the UC San Diego Moores Cancer Center, discuss the diagnosis and treatment of rash, itching, and related imAEs.