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Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

Schneider, Bryan J., Naidoo, Jarushka, Santomasso, Bianca D., Lacchetti, Christina, Adkins, Sherry, Anadkat, Milan, Atkins, Michael B., Brassil, Kelly J., Caterino, Jeffrey M., Chau, Ian, Davies, Marianne J., Ernstoff, Marc S., Fecher, Leslie, Ghosh, Monalisa, Jaiyesimi, Ishmael, Mammen, Jennifer S., Naing, Aung, Nastoupil, Loretta J., Phillips, Tanyanika, Porter, Laura D., Reichner, Cristina A., Seigel, Carole, Song, Jung-Min, Spira, Alexander, Suarez-Almazor, Maria, Swami, Umang, Thompson, John A., Vikas, Praveen, Wang, Yinghong, Weber, Jeffrey S., Funchain, Pauline, Bollin, Kathryn·2021·Journal of Clinical Oncology

DOI 10.1200/jco.21.01440

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Abstract

PURPOSE: To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS: A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS: A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS: Recommendations for specific organ system–based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines .

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AASLD practice guidance on drug, herbal, and dietary supplement–induced liver injury
Fontana, R. J., Liou, I., Reuben, A., Suzuki, A., Fiel, M. I., Lee, W., & Navarro, V. (2023) · Hepatology · doi:10.1002/hep.32689 · Cited by 340
9. pharmacologic approaches to glycemic treatment: standards of care in diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s009 · Cited by 263
Abatacept/Ruxolitinib and Screening for Concomitant Respiratory Muscle Failure to Mitigate Fatality of Immune-Checkpoint Inhibitor Myocarditis
Salem, J.-E., Bretagne, M., Abbar, B., Leonard-Louis, S., Ederhy, S., Redheuil, A., Boussouar, S., Nguyen, L. S., Procureur, A., Stein, F., et al. (2023) · Cancer Discovery · doi:10.1158/2159-8290.cd-22-1180 · Cited by 243
Advances in molecular pathology and therapy of non-small cell lung cancer
Huang, Q., Li, Y., Huang, Y., Wu, J., Bao, W., Xue, C., Li, X., Dong, S., Dong, Z., & Hu, S. (2025) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-025-02243-6 · Cited by 197
Clinical spectrum and evolution of immune-checkpoint inhibitors toxicities over a decade—a worldwide perspective
Gougis, P., Jochum, F., Abbar, B., Dumas, E., Bihan, K., Lebrun-Vignes, B., Moslehi, J., Spano, J.-P., Laas, E., Hotton, J., et al. (2024) · eClinicalMedicine · doi:10.1016/j.eclinm.2024.102536 · Cited by 161

See all 2,372

Authors: Schneider, B. J., Naidoo, J., Santomasso, B. D., Lacchetti, C., Adkins, S., Anadkat, M., Atkins, M. B., Brassil, K. J., Caterino, J. M., Chau, I., Davies, M. J., Ernstoff, M. S., Fecher, L., Ghosh, M., Jaiyesimi, I., Mammen, J. S., Naing, A., Nastoupil, L. J., Phillips, T., Porter, L. D., Reichner, C. A., Seigel, C., Song, J.-M., Spira, A., Suarez-Almazor, M., Swami, U., Thompson, J. A., Vikas, P., Wang, Y., Weber, J. S., Funchain, P., & Bollin, K.
Affiliations: University of Michigan Health System, Ann Arbor, MI
Beaumont Hospital, Dublin, Ireland
Memorial Sloan Kettering Cancer Center, New York, NY
American Society of Clinical Oncology, Alexandria, VA
MD Anderson Cancer Center, Houston, TX
Washington University, St Louis, MO
Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
The Ohio State University Wexner Medical Center, Columbus, OH
Royal Marsden Hospital and Institute of Cancer Research, London & Surrey, Sutton, UK
Smilow Cancer Hospital and Yale School of Nursing; New Haven, CT
National Cancer Institute, Bethesda, MD
University of Michigan, Ann Arbor, MI
Cancer Care Associates PC, Royal Oak, MI
Johns Hopkins University, Baltimore, MD
City of Hope, Duarte, CA
Patient Advocate, Colon Cancer Alliance, Washington, DC
Georgetown University, Washington, DC
Patient Advocate, MGH Cancer Center, Boston, MA
Cleveland Clinic, Cleveland, OH
Virginia Cancer Specialists and US Oncology, Fairfax, VA
Huntsman Cancer Institute—University of Utah, Salt Lake City, UT
Seattle Cancer Care Alliance, University of Washington/Fred Hutchinson, Seattle, WA
University of Iowa, Iowa City, IA
NYU Langone Medical Center, New York, NY
Scripps MD Anderson Cancer Center, San Diego, CA
ORCID: Schneider, Bryan J.
Naidoo, Jarushka
Lacchetti, Christina
Adkins, Sherry
Atkins, Michael B.
Brassil, Kelly J.
Chau, Ian
Davies, Marianne J.
Ernstoff, Marc S.
Fecher, Leslie
Ghosh, Monalisa
Mammen, Jennifer S.
Naing, Aung
Porter, Laura D.
Spira, Alexander
Suarez-Almazor, Maria
Swami, Umang
Vikas, Praveen
Wang, Yinghong
Weber, Jeffrey S.
Funchain, Pauline
Bollin, Kathryn
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2021-12-20
Volume: 39
Issue: 36
Pages: 4073-4126
ISSN: 0732-183X
1527-7755
DOI: 10.1200/jco.21.01440
Cited by: 2,372
References: 37
Language: en
Update notices: correction (2022-01-14)

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Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

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