Resources Are Available to Guide Management of Immunotherapy-Related Adverse Events

April 10, 2019

Immunotherapy has evolved into the “fourth pillar” of cancer care, along with surgery, chemotherapy and radiation therapy, according to Laura S. Wood RN, MSN, OCN®, of the Cleveland Clinic Taussig Cancer Center in Ohio and Krista M. Rubin, MS, RN, FNP-BC, of Massachusetts General Hospital in Boston, who spoke during a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA. Immunotherapeutic agents, however, are vastly different from chemotherapies and have a distinct toxicity profile that advanced practice nurses must be familiar with.

Immune-related adverse events (irAEs) are diverse, potentially affecting almost any body system. The successful management of irAEs has seven key components (see sidebar).


Tools to Manage irAEs

Several professional organizations involved in caring for patients receiving immunotherapy, including the American Society of Clinical Oncology (ASCO) and the Society for Immunotherapy of Cancer (SITC), have developed guidelines for managing irAEs. Most of the guidelines are algorithm based and offer management recommendations based on the Common Toxicity Criteria for Adverse Events grading system.

Key points in the ASCO guidelines include:

According to the SITC guidelines, detailed pretreatment screening is important, including history, blood tests (e.g., HgbA1c, total CK, fasting lipid profile). Patients with pre-existing organ disease should also be screened for cortisol and adrenocorticotropin as well as brain natriuretic peptide (BNP) or N pro-BNP and should undergo pulmonary function tests.

The SITC guidelines focus on the clinical presentation and epidemiology of each irAE and encourage referral and multidisciplinary care. Specific recommendations include:

More information and tools for irAE management are readily available online, including ONS’s immunotherapy wallet cards and other immunotherapy resources.

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