PT  - JOURNAL ARTICLE
AU  - Puzanov, I.
AU  - Diab, A.
AU  - Abdallah, K.
AU  - Bingham, C. O.
AU  - Brogdon, C.
AU  - Dadu, R.
AU  - Hamad, L.
AU  - Kim, S.
AU  - Lacouture, M. E.
AU  - LeBoeuf, N. R.
AU  - Lenihan, D.
AU  - Onofrei, C.
AU  - Shannon, V.
AU  - Sharma, R.
AU  - Silk, A. W.
AU  - Skondra, D.
AU  - Suarez-Almazor, M. E.
AU  - Wang, Y.
AU  - Wiley, K.
AU  - Kaufman, H. L.
AU  - Ernstoff, M. S.
AU  - on behalf of the Society for Immunotherapy of Cancer Toxicity Management Working Group
AU  - Anderson, Jeff
AU  - Arrindell, Deborah
AU  - Andrews, Stephanie
AU  - Ballesteros, Joan
AU  - Boyer, Janie
AU  - Chen, Daniel
AU  - Chonzi, David
AU  - Cotarla, Ion
AU  - Cunha, Renato
AU  - Davies, Marianne
AU  - Dawson, Michelle
AU  - Dicker, Adam
AU  - Eifler, Lisa
AU  - Ferguson, Andrew
AU  - Ferlini, Cristiano
AU  - Frankel, Stanley
AU  - Go, William
AU  - Gochett, Celestine
AU  - Goldberg, Jenna
AU  - Goncalves, Priscila
AU  - Goswami, Trishna
AU  - Gregory, Nancy
AU  - Gulley, James L.
AU  - Hayreh, Vinny
AU  - Helie, Nicole
AU  - Holmes, William
AU  - Hsu, Jer-Yuan
AU  - Ibrahim, Ramy
AU  - Larocca, Cecilia
AU  - Lehman, Kimberly
AU  - Ley-Acosta, Sergio
AU  - Lambotte, Olivier
AU  - Luke, Jason
AU  - McClure, Joan
AU  - Michelon, Elisabete
AU  - Nakamura, Mary
AU  - Patel, Kiran
AU  - Piperdi, Bilal
AU  - Rasheed, Zeshaan
AU  - Reshef, Dan
AU  - Riemer, Joanne
AU  - Robert, Caroline
AU  - Sarkeshik, Makan
AU  - Saylors, Ann
AU  - Schreiber, Judy
AU  - Shafer-Weaver, Kim
AU  - Sharfman, William
AU  - Sharon, Elad
AU  - Sherry, Richard
AU  - Simonson, Cyndy
AU  - Thomas, Cherry
AU  - Thompson, John A.
AU  - Trehu, Elizabeth
AU  - Tresnan, Dina
AU  - Turner, Michelle
AU  - Wariabharaj, Darshan
AU  - Waxman, Ian
AU  - Wood, Lauren
AU  - Zhang, Lin
AU  - Zheng, Pan
TI  - Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group
AID  - 10.1186/s40425-017-0300-z
DP  - 2017 Dec 01
TA  - Journal for ImmunoTherapy of Cancer
PG  - 95
VI  - 5
IP  - 1
4099  - http://jitc.bmj.com/content/5/1/95.short
4100  - http://jitc.bmj.com/content/5/1/95.full
SO  - J Immunother Cancer2017 Dec 01; 5
AB  - Cancer immunotherapy has transformed the treatment of cancer. However, increasing use of immune-based therapies, including the widely used class of agents known as immune checkpoint inhibitors, has exposed a discrete group of immune-related adverse events (irAEs). Many of these are driven by the same immunologic mechanisms responsible for the drugs’ therapeutic effects, namely blockade of inhibitory mechanisms that suppress the immune system and protect body tissues from an unconstrained acute or chronic immune response. Skin, gut, endocrine, lung and musculoskeletal irAEs are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently. The majority of irAEs are mild to moderate in severity; however, serious and occasionally life-threatening irAEs are reported in the literature, and treatment-related deaths occur in up to 2% of patients, varying by ICI. Immunotherapy-related irAEs typically have a delayed onset and prolonged duration compared to adverse events from chemotherapy, and effective management depends on early recognition and prompt intervention with immune suppression and/or immunomodulatory strategies. There is an urgent need for multidisciplinary guidance reflecting broad-based perspectives on how to recognize, report and manage organ-specific toxicities until evidence-based data are available to inform clinical decision-making. The Society for Immunotherapy of Cancer (SITC) established a multidisciplinary Toxicity Management Working Group, which met for a full-day workshop to develop recommendations to standardize management of irAEs. Here we present their consensus recommendations on managing toxicities associated with immune checkpoint inhibitor therapy.Abbreviations:2-D echoTwo-dimensional echocardiogram/echocardiography6MWT6 min walk testAACRAmerican Association for Cancer ResearchACCCAssociation of Community Cancer CentersACPAAnti-citrullinated protein antibodiesACTHAdrenocorticotropic hormoneADCCAntibody-dependent cell-mediated cytotoxicityADLActivities of daily livingALTAlanine aminotransferaseANAAntinuclear antibodyAnti-CCPCyclic citrullinated peptide antibodyAnti-RFAnti-rheumatoid factor (anti-RF)Anti-TNFAnti-tumor necrosis factorASCOAmerican Society of Clinical OncologyASTAspartate aminotransferaseATGAnti-thymocyte globulinBALBronchoalveolar lavageBIDTwo times dailyBNPB-type natriuretic peptideBSABody surface areaCBCComplete blood countCKCreatine kinaseCMPComplete metabolic panelCMVCytomegalovirusCNSCentral Nervous SystemCOPCryptogenic organizing pneumoniaCOPDChronic obstructive pulmonary diseaseCRPC-reactive proteinCTComputed tomographyCTCAECommon Terminology Criteria for Adverse EventsCTLA-4Cytotoxic T lymphocyte-antigen-4DICDisseminated intravascular coagulationDLCODiffusing capacity of the lungs for carbon monoxideDMARDSDisease modifying anti-rheumatic drugsDRESSDrug rash with eosinophilia and systemic symptomsEBUSEndobronchial ultrasoundECGElectrocardiogramESRErythrocyte sedimentation rateFDAU.S. Food and Drug AdministrationFDG-PETFluorodeoxyglucose positron emission tomographyFNAFine needle aspirationFOBTFecal occult blood testFreeT4Free thyroxineFSHFollicle-stimulating hormoneFVCForced vital capacityGAD65Glutamic acid decarboxylaseGCAGiant cell arteritisGIGastrointestinalHbA1cGlycated hemoglobinHBcAbHepatitis B core antibodyHBsAbHepatitis B surface antibodyHBsAgHepatitis B surface antigenHCAbHepatitis C antibodyHgbHemoglobinHIVHuman immunodeficiency virusHPHypersensitivity pneumonitisHRTHormone Replacement TherapyHSVHerpes simplex virusIBDInflammatory bowel diseaseICIsImmune checkpoint inhibitorsICUIntensive care unitIFImmunofluorescenceIgEImmunoglobulin EIgG1Immunoglobulin G1IgG4Immunoglobulin G4irAEsImmune-related adverse eventsIVIGIntravenous immunoglobulinLHLuteinizing hormoneLLNLower limit of NormalmAbsMonoclonal antibodiesMCPMetacarpophalangealMedDRAMedical Dictionary for Regulatory ActivitiesMRIMagnetic resonance imagingNCCNNational Comprehensive Cancer NetworkNCINational Cancer InstituteNIHNational Institutes of HealthNSCLCNon-small cell lung carcinomaNSIPNonspecific interstitial pneumonitisNT pro-BNPN-terminal pro B-type natriuretic peptideONSOncology Nursing SocietyPASIpsoriasis area severity indexPCRPolymerase chain reactionPD-1Programmed cell death protein-1PD-L1Programmed cell death-ligand 1PFPulmonary fibrosisPFTsPulmonary function testsPIPProximal interphalangealPMRPolymyalgia rheumaticPRESPosterior Reversible Encephalopathy SyndromeQIDFour times dailyRARheumatoid arthritisRAIUSRadioactive iodine uptake scanSITCSociety for Immunotherapy of CancerSJS/TENStevens-Johnson Syndrome/toxic epidermal necrolysisSLESystemic lupus erythematosusT1DMType I DiabetesT3TriiodothyronineTBBxTransbronchial lung biopsyTcTechnetiumTh17.1T helper 17 cellsTLCTotal lung capacityTNFiTumor necrosis factor inhibitorTPOThyroid peroxidaseTRAbThyroid-stimulating hormone receptor antibodyTSHThyroid-stimulating hormoneTSIThyroid-stimulating immunoglobulinUIPUsual interstitial pneumonitisULNUpper Limit of NormalUVBShort wave ultraviolet BVZVVaricella zoster virusZn-T8Zinc transporter 8