Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper
Open accessAbstract
Monoclonal antibodies targeted against the immune checkpoint molecules CTLA-4 and PD-1 have recently obtained approval for the treatment of metastatic melanoma and advanced/refractory non small-cell lung cancers. Therefore, their use will not be limited anymore to selected hospitals involved in clinical trials. Indeed, they will be routinely prescribed in many cancer centers across the world. Besides their efficacy profile, these immune targeted agents also generate immune-related adverse events (irAEs). This new family of dysimmune toxicities remains largely unknown to the broad oncology community. Although severe irAEs remain rare (∼10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. Over the last 5 years, Gustave Roussy has accumulated a significant experience in the prescription of immune checkpoint blockade (ICB) antibodies and the management of their toxicities. Together with the collaboration of Gustave Roussy's network of organ specialists with expertise in irAEs, we propose here some practical guidelines for the oncologist to help in the clinical care of patients under ICB immunotherapy.
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Corticosteroids are the usual first-line treatment for both reactive eosinophilic disorders and irAEs.
“Corticosteroids are the usual first-line treatment for both reactive eosinophilic disorders and irAEs.2,7,23”
From Moderate-to-severe eosinophilia induced by treatment with immune checkpoint inhibitors: 37 cases from a national reference center for hypereosinophilic syndromes and the French pharmacovigilance database (2020) · cites this paper as [2]
Table 4 (p. 571) recommends corticosteroids for grade 2–4 irAEs, with other immunosuppressive drugs considered if symptoms persist; it does not recommend corticosteroids for grade 1 irAEs. The paper does not address first-line treatment of reactive eosinophilic disorders, so it supports only the irAE part of the claim. (LLM, conf=0.88)
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Solomon, L. R. (2015) · Acta Oncologica · doi:10.3109/0284186x.2014.1002572 · Cited by 10 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
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Cited by
Sorted by citations
Brahmer, J. R., Lacchetti, C., Schneider, B. J., Atkins, M. B., Brassil, K. J., Caterino, J. M., Chau, I., Ernstoff, M. S., Gardner, J. M., Ginex, P., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.77.6385 · Cited by 3,713 · see citing works
Haanen, J. B. A. G., Carbonnel, F., Robert, C., Kerr, K. M., Peters, S., Larkin, J., & Jordan, K. (2017) · Annals of Oncology · doi:10.1093/annonc/mdx225 · Cited by 2,367 · see citing works
Self-citationToi, Y., Sugawara, S., Sugisaka, J., Ono, H., Kawashima, Y., Aiba, T., Kawana, S., Saito, R., Aso, M., Tsurumi, K., et al. (2019) · JAMA Oncology · doi:10.1001/jamaoncol.2018.5860 · Cited by 352 · see citing works
Santini, F. C., Rizvi, H., Plodkowski, A. J., Ni, A., Lacouture, M. E., Gambarin-Gelwan, M., Wilkins, O., Panora, E., Halpenny, D. F., Long, N. M., et al. (2018) · Cancer Immunology Research · doi:10.1158/2326-6066.cir-17-0755 · Cited by 331 · see citing works
Tocilizumab for the management of immune mediated adverse events secondary to PD-1 blockade
Stroud, C. R., Hegde, A., Cherry, C., Naqash, A. R., Sharma, N., Addepalli, S., Cherukuri, S., Parent, T., Hardin, J., & Walker, P. (2019) · Journal of Oncology Pharmacy Practice · doi:10.1177/1078155217745144 · Cited by 331 · see citing works
Treatment Outcomes of Immune-Related Cutaneous Adverse Events
Phillips, G. S., Wu, J., Hellmann, M. D., Postow, M. A., Rizvi, N. A., Freites-Martinez, A., Chan, D., Dusza, S., Motzer, R. J., Rosenberg, J. E., et al. (2019) · Journal of Clinical Oncology · doi:10.1200/jco.18.02141 · Cited by 241 · see citing works
Histopathologic Features of Colitis Due to Immunotherapy With Anti-PD-1 Antibodies
Chen, J. H., Pezhouh, M. K., Lauwers, G. Y., & Masia, R. (2017) · American Journal of Surgical Pathology · doi:10.1097/pas.0000000000000829 · Cited by 186 · see citing works
Hayase, E., & Jenq, R. R. (2021) · Genome Medicine · doi:10.1186/s13073-021-00923-w · Cited by 145 · see citing works
PD1/PDL1 inhibitors for the treatment of advanced urothelial bladder cancer
Stenehjem, D., Tran, D., Nkrumah, M., & Gupta, S. (2018) · OncoTargets and Therapy · doi:10.2147/ott.s135157 · Cited by 144 · see citing works
French Endocrine Society guidance on endocrine side effects of immunotherapy
Castinetti, F., Albarel, F., Archambeaud, F., Bertherat, J., Bouillet, B., Buffier, P., Briet, C., Cariou, B., Caron, P., Chabre, O., et al. (2019) · Endocrine Related Cancer · doi:10.1530/erc-18-0320 · Cited by 140 · see citing works
Self-citationAutoimmune endocrine dysfunctions associated with cancer immunotherapies
Ferrari, S. M., Fallahi, P., Elia, G., Ragusa, F., Ruffilli, I., Patrizio, A., Galdiero, M. R., Baldini, E., Ulisse, S., Marone, G., et al. (2019) · International Journal of Molecular Sciences · doi:10.3390/ijms20102560 · Cited by 107 · see citing works
Horisberger, A., La Rosa, S., Zurcher, J.-P., Zimmermann, S., Spertini, F., Coukos, G., & Obeid, M. (2018) · Journal for ImmunoTherapy of Cancer · doi:10.1186/s40425-018-0481-0 · Cited by 81 · see citing works
Immune-related eosinophilia induced by anti-programmed death 1 or death-ligand 1 antibodies.
Bernard-Tessier, A., Jeanville, P., Champiat, S., Lazarovici, J., Voisin, A.-L., Mateus, C., Lambotte, O., Annereau, M., & Michot, J.-M. (2017) · European Journal of Cancer · doi:10.1016/j.ejca.2017.05.017 · Cited by 78 · see citing works
Self-citationScanvion, Q., Béné, J., Gautier, S., Grandvuillemin, A., Le Beller, C., Chenaf, C., Etienne, N., Brousseau, S., Cortot, A. B., Mortier, L., et al. (2020) · OncoImmunology · doi:10.1080/2162402x.2020.1722022 · Cited by 59 · see citing works
“These drugs have been approved for the treatment of several cancers, including melanoma, non-small-cell lung cancer, urothelial carcinoma, renal cell carcinoma, squamous cell carcinoma of the head and the neck, and/or Hodgkin’s lymphoma.(2) However, ICIs are also associated with frequent and potentially organ- or life…”
Background
- Authors
- Champiat, S., Lambotte, O., Barreau, E., Belkhir, R., Berdelou, A., Carbonnel, F., Cauquil, C., Chanson, P., Collins, M., Durrbach, A., Ederhy, S., Feuillet, S., François, H., Lazarovici, J., Le Pavec, J., De Martin, E., Mateus, C., Michot, J.-M., Samuel, D., Soria, J.-C., Robert, C., Eggermont, A., & Marabelle, A.
- Affiliations
- Inserm (FR)
- Université Paris-Sud (FR)
- Bicêtre Hospital (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Université Paris-Saclay (FR)
- Institut Gustave Roussy (FR)
- Corresponding author
- Marabelle, A.
- ORCID
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 27
- Issue
- 4
- Pages
- 559-574
- ISSN
- 0923-7534 (ISSN-L)
- OpenAlex
- W2289841322
- Semantic Scholar
- 6f7fdc9c00acb9d364605062654a4ee65c9212d8
- Cited by
- 903
- References
- 83
- Citations by year
- 2026: 25 · 2025: 45 · 2024: 60 · 2023: 61 · 2022: 86 · 2021: 122 · 2020: 123 · 2019: 121 · 2018: 115 · 2017: 107 · 2016: 37
- FWCI
- 37.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- immune checkpoint blockade, immune-related adverse events, immune dysregulation, CTLA-4 inhibitors, PD-1 inhibitors, immune checkpoint inhibitors, metastatic melanoma, non-small cell lung cancer
- MeSH terms
- Antibodies, Monoclonal, Carcinoma, Non-Small-Cell Lung, Humans, Immunotherapy, Melanoma, Disease Management, CTLA-4 Antigen, Programmed Cell Death 1 Receptor, Drug-Related Side Effects and Adverse Reactions
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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