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PD-1 found in T cells is responsible for regulating immune response.

PD-1 found in T cells is responsible for regulating immune response.

Severe toxicities require treatment with high-dose glucocorticoid therapy.

Severe toxicities require treatment with high-dose glucocorticoid therapy.

Immunotherapy-induced inflammation can affect any organ system in the body.

Immunotherapy-induced inflammation can affect any organ system in the body.

Given the effectiveness of immunotherapy in targeting cancer cells, identifying individuals who may be susceptible to adverse reactions is crucial to successful treatment.

Given the effectiveness of immunotherapy in targeting cancer cells, identifying individuals who may be susceptible to adverse reactions is crucial to successful treatment.

Toxicities occur in most patients treated with immune checkpoint inhibitors, although more clinically severe toxicities arise in approximately 20% to 50%.

Toxicities occur in most patients treated with immune checkpoint inhibitors, although more clinically severe toxicities arise in approximately 20% to 50%.

For Providers

Toxicity Overview

Toxicities occur in most patients treated with immune checkpoint inhibitors, although more clinically severe toxicities arise in approximately 20% (anti-PD-1 or PD-L1 monotherapy) to 50% (combination PD-1/CTLA-4 blockade). Toxicities are autoimmune-like inflammation that may affect any organ system. The management of toxicities is largely based on severity and grade (see guidelines/CTCAE).

Mild and minimally symptomatic toxicities may be managed with supportive care and close monitoring (e.g., topical steroids for a mild rash). 

Severe and life-threatening toxicities usually require the following:

  • High-dose glucocorticoid therapy (prednisone 1-2mg/kg or equivalent)
  • Withholding immune checkpoint inhibitor therapy
  • Supportive management (e.g., supplemental oxygen for hypoxia in pneumonitis)

Additional Resources

Review of Immune Checkpoint Inhibitor Toxicity

Brief Review of Immune Checkpoint Inhibitor Toxicity

NCCN/ASCO Guidelines

SITC Guidelines

ESMO Guidelines

Cardio Oncology Resources

Center for Drug Safety and Immunology [TBA]