Immunotherapy toxicity management
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| Section editor | |
|---|---|
| Meghan Mooradian, MD Boston, MA | |
Grading toxicity
CTCAE
- Common Terminology Criteria for Adverse Events (CTCAE) and Common Toxicity Criteria (CTC) - Adverse event grading for clinical trials
Diarrhea, colitis
Endocrinopathy
Fatigue
Liver, hepatic
Lung, pneumonitis
Kidney, renal
Neurologic
Ocular
Pancreas
Skin, dermatologic
Guidelines
- ESMO: Management of Toxicities from Immunotherapy: ESMO Clinical Practice Guidelines (2017)
- SITC: Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group
- Naidoo J, Page DB, Li BT, Connell LC, Schindler K, Lacouture ME, Postow MA, Wolchok JD. Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Ann Oncol. 2015 Dec;26(12):2375-91. link to original article correction of Figure 2 PubMed
Evaluation
Endocrinopathy
- ACTH
- AM cortisol with cosyntropin stimulation test
- TSH
- FSH
- LH
- Prolactin
- Testosterone
Liver, hepatic
- Liver function tests (LFTs) or comprehensive metabolic panel (CMP)
- Hepatitis B & C serologies
- Liver/abdominal CT/MRI/ultrasound imaging
Kidney, renal
- BUN/creatinine, basic metabolic panel (BMP)
- Renal imaging (CT/MRI/ultrasound imaging)
- Urine sodium, urine urea, urine creatinine (for calculating FeNa and FeUrea)
- Kidney biopsy
Neurologic
- Electromyography (EMG)
Ocular
- Ophthalmology exam
Pancreas
- Amylase
- Lipase