Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events
Abstract The application of immune checkpoint inhibitors (ICIs) has rewritten many malignant tumor treatment strategies and become another milestone in tumor treatment. This article summarizes the latest domestic and international guidelines and consensus regarding the diagnosis and treatment of gra...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-08-01
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| Series: | Thoracic Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/1759-7714.13553 |
| _version_ | 1828398217973202944 |
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| author | Peng Song Hanping Wang Xiaoyan Si Xiaoxiao Guo Yue Li Jiaixin Zhou Lian Duan Li Zhang Mengzhao Wang |
| author_facet | Peng Song Hanping Wang Xiaoyan Si Xiaoxiao Guo Yue Li Jiaixin Zhou Lian Duan Li Zhang Mengzhao Wang |
| author_sort | Peng Song |
| collection | DOAJ |
| description | Abstract The application of immune checkpoint inhibitors (ICIs) has rewritten many malignant tumor treatment strategies and become another milestone in tumor treatment. This article summarizes the latest domestic and international guidelines and consensus regarding the diagnosis and treatment of grade 3–4 immune‐related adverse effects (irAEs). Included are the findings of annual meetings of the European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network/American Society for Clinical Oncology (NCCN/ASCO), the Society for Immunotherapy of Cancer (SITC), and the Chinese Society of Clinical Oncology (CSCO) with review of case reports and related reviews of irAEs that were published before 20 May 2019. The recommendations for the diagnosis and treatment of irAEs are supplemented, highlighting the successful application of specific immunosuppressive drugs in different irAEs, including IL‐6 blockade, anti‐CD20 monoclonal antibody, antitumor necrosis factor alpha and anti‐integrin 4 monoclonal antibodies, thrombopoietin receptor agonist, and antithymocyte globulin. This article questions the use of steroid hormones for irAEs in ultra‐large doses, upgrades, and repeated use, and emphasizes that it is important to note secondary infections, tumor progression, and the inability to meet the challenges of ICIs. Herein, we propose the principle of “stepping down treatment” for critical and refractory irAEs, and suggest that the use of specific immunosuppressive drugs such as cytokine‐targeted drugs should be initiated as soon as possible. Many irAEs in the era of immunotherapy are unprecedented in the era of traditional chemotherapy and small molecule targeted therapy, and this constantly challenges the knowledge reserve and clinical skills of oncologists. Therefore, the establishment of a multidisciplinary discussion system for cancer is extremely important. |
| first_indexed | 2024-12-10T08:57:49Z |
| format | Article |
| id | doaj.art-db35dbd6f4bd405eb02bedccad706d3e |
| institution | Directory Open Access Journal |
| issn | 1759-7706 1759-7714 |
| language | English |
| last_indexed | 2024-12-10T08:57:49Z |
| publishDate | 2020-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Thoracic Cancer |
| spelling | doaj.art-db35dbd6f4bd405eb02bedccad706d3e2022-12-22T01:55:22ZengWileyThoracic Cancer1759-77061759-77142020-08-011182077208610.1111/1759-7714.13553Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse eventsPeng Song0Hanping Wang1Xiaoyan Si2Xiaoxiao Guo3Yue Li4Jiaixin Zhou5Lian Duan6Li Zhang7Mengzhao Wang8Department of Respiratory Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Respiratory Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Respiratory Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Cardiology Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Gastroenterology Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Rheumatology Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Endocrinology Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Respiratory Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaDepartment of Respiratory Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College Beijing ChinaAbstract The application of immune checkpoint inhibitors (ICIs) has rewritten many malignant tumor treatment strategies and become another milestone in tumor treatment. This article summarizes the latest domestic and international guidelines and consensus regarding the diagnosis and treatment of grade 3–4 immune‐related adverse effects (irAEs). Included are the findings of annual meetings of the European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network/American Society for Clinical Oncology (NCCN/ASCO), the Society for Immunotherapy of Cancer (SITC), and the Chinese Society of Clinical Oncology (CSCO) with review of case reports and related reviews of irAEs that were published before 20 May 2019. The recommendations for the diagnosis and treatment of irAEs are supplemented, highlighting the successful application of specific immunosuppressive drugs in different irAEs, including IL‐6 blockade, anti‐CD20 monoclonal antibody, antitumor necrosis factor alpha and anti‐integrin 4 monoclonal antibodies, thrombopoietin receptor agonist, and antithymocyte globulin. This article questions the use of steroid hormones for irAEs in ultra‐large doses, upgrades, and repeated use, and emphasizes that it is important to note secondary infections, tumor progression, and the inability to meet the challenges of ICIs. Herein, we propose the principle of “stepping down treatment” for critical and refractory irAEs, and suggest that the use of specific immunosuppressive drugs such as cytokine‐targeted drugs should be initiated as soon as possible. Many irAEs in the era of immunotherapy are unprecedented in the era of traditional chemotherapy and small molecule targeted therapy, and this constantly challenges the knowledge reserve and clinical skills of oncologists. Therefore, the establishment of a multidisciplinary discussion system for cancer is extremely important.https://doi.org/10.1111/1759-7714.13553Adverse eventscriticalrefractoryimmune checkpoint inhibitor |
| spellingShingle | Peng Song Hanping Wang Xiaoyan Si Xiaoxiao Guo Yue Li Jiaixin Zhou Lian Duan Li Zhang Mengzhao Wang Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events Thoracic Cancer Adverse events critical refractory immune checkpoint inhibitor |
| title | Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events |
| title_full | Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events |
| title_fullStr | Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events |
| title_full_unstemmed | Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events |
| title_short | Recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor‐associated adverse events |
| title_sort | recommendations and exploration of diagnosis and treatment of critical and refractory immune checkpoint inhibitor associated adverse events |
| topic | Adverse events critical refractory immune checkpoint inhibitor |
| url | https://doi.org/10.1111/1759-7714.13553 |
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