Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Abstract

Immunotherapy with monoclonal antibodies (MoAbs) targeting cytotoxic T lymphocyte-associated antigen 4 (CTLA4) and the programmed death-1 receptor (PD-1) and its ligand PD-L1 has become standard of care for an increasing number of indications (Table 1). Therefore, an increasing number of patients will be exposed to these drugs with a chance of developing toxicities from these treatments. Depending on the immune checkpoint that is targeted, the incidence of toxicity varies. Toxicities from immune checkpoint inhibitors (ICPis) can be divided into infusion reactions and immune-related adverse events (irAEs) or adverse events of special interest (AEoSI). The latter will be the subject of these Clinical Practice Guidelines. Any organ or tissue can be involved, although some irAEs occur much more commonly than others. The most frequently occurring irAEs affect skin, colon, endocrine organs, liver and lungs. Others are very infrequent, but may be very serious, even lethal, such as neurological disorders and myocarditis.