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]