John A. Thompson, MD
In recognition of the variety of immune-related adverse events (irAEs) that patients receiving checkpoint blockade immunotherapy may experience, the National Comprehensive Cancer Network (NCCN) has developed its first set of recommendations to help clinicians manage toxicities.1
The guidelines provide step-by-step flowcharts for recognizing and responding to 25 toxicities and offer advice on educating patients about irAEs.
“Patients are familiar with the idea that the immune system will keep on attacking any foreign cells [cancers] that it learns to recognize because most are familiar with vaccines,” Thompson said. “Once we’ve convinced patients that immunotherapy seems to have the same durable effect in cancer treatment, then patients tend to buy in and report potential toxicities as they arise.”
Toxicity Profiles Differ
Currently, there are 6 FDA-approved immune checkpoint inhibitors: ipilimumab (Yervoy; anti–CTLA-4), nivolumab (Opdivo; anti–PD-1), pembrolizumab (Keytruda; anti–PD-1), atezolizumab (Tecentriq; anti–PD-L1), avelumab (Bavencio; anti–PD-L1), and durvalumab (Imfinzi; anti–PD-L1).
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