Immune-Mediated Adverse Events
imAEs can be different from side effects 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.4-6
While imAEs can affect any organ or tissue, the most commonly affected areas are2,3:
Early recognition and monitoring of all imAEs can help manage adverse events before they become more serious and cause treatment interruption.6
Follow a clear management algorithm for all grades of toxicities
Understand when a specialist should be contacted to help manage imAEs
Consult applicable product label for specific recommendations. In general, the management of imAEs may include the use of corticosteroids or other immunosuppressive agents.4,6
Watch the videos below to learn more about the diagnosis and treatment of imAEs related to the most commonly affected organs.
Hear from thought leaders in oncology on the diagnosis and management of imAEs.
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Expert points of view
“As immuno-oncology treatments multiply, one challenge is learning to recognize and manage unique immune-mediated adverse events.”
— Dr Antonia
“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
“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
“Immune-related nephritis is, luckily, a fairly rare scenario. It occurs well under 1% of the time.”
— Dr Weber
“Hepatitis is almost always asymptomatic and that is why we always incorporate blood tests and liver function tests into our workups.”
— Dr Antonia
“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
“What we tell patients about skin reactions is that this tends to be one of the earlier side effects they may notice.”
— Dr Cohen
SCAR, severe cutaneous adverse reactions; SJS, Stevens-Johnson syndrome; TENS, toxic epidermal necrolysis; DRESS, drug reaction with eosinophilia and systemic symptoms; DIHS, drug-induced hypersensitivity syndrome.
1. Gangadhar TC, Vonderheide RH. Mitigating the toxic effects of anticancer immunotherapy. Nat Rev Clin Oncol. 2014;11:91-99. 2. Nishijima TF, Shachar SS, Nyrop KA, Muss HB. Safety and tolerability of PD-1/PD-L1 inhibitors compared with chemotherapy in patients with advanced cancer: a meta-analysis. Oncologist. 2017;22:1-10. 3. Spain L, Diem S, Larkin J. Complications of treatment: management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev. 2016;44:51-60. 4. Postow MA, Callahan MK, Wolchok JD. Immune checkpoint blockade in cancer therapy. J Clin Oncol. 2015;33(17):1974-1982. 5. Weber JS, Yang JC, Atkins MB, Disis ML. Toxicities of immunotherapy for the practitioner. J Clin Oncol. 2015;33(18):2092-2099. 6. Kumar V, Chaudhary N, Garg M, Floudas CS, Soni P, Chandra AB. Current diagnosis and management of immune related adverse events (irAEs) induced by immune checkpoint inhibitor therapy. Front Pharmacol. 2017;8:1-14. doi:10.3389/ fphar.2017.00049. 7. Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018:JCO2017776385. 8. Friedman CF, Proverbs-Singh TA, Postow MA. Treatment of the immune-related adverse effects of immune checkpoint inhibitors. JAMA Oncol. 2016;2(10):1346-1353. 9. Voskens CJ, Goldinger SM, Loquai C, et al. The price of tumor control: an analysis of rare side effects of anti-CTLA-4 therapy in metastatic melanoma from the ipilimumab network. PLoS ONE. 2013;8(1):e53745. doi:10.1371/ journal.pone.0053745.