Summary of the recommended strategies for effective management of immune-related adverse events (irAEs)
| Action items | Recommended strategies | |
| 1 | Providing patient education | Use drug-specific wallet cards, educational apps, social networks, and support groups to provide information regarding irAEs and symptom monitoring |
| Tailor patient education resources to preferences, and, emotional, literacy, and cultural needs of the patient | ||
| 2 | Refining irAE management guidelines | Convene an irAE Management Summit |
| Develop toxicity-specific management committees to create evidence-based expert consensus guidelines | ||
| Include broad perspectives, such as emergency room physicians, anesthesiologists and surgeons, primary care physicians, patient advocates, and nurses, in guideline development/review | ||
| Publish the outcomes of the activities of the proposed summit | ||
| Make the summit a regularly planned effort | ||
| 3 | Standardizing reporting of irAEs | Incorporate SITC CTCAE Task Force irAE-specific module into future versions of the CTCAE |
| 4 | Optimizing the choice of immunosuppressive agents | Conduct prospective studies to evaluate safety and efficacy of immunosuppressant agents in irAE management and their impact on response to immune checkpoint inhibitor therapy to optimize the choice, dosing, and duration of use of immunosuppressants in management of irAEs |
| 5 | Pursuing better understanding of irAEs | Conduct more preclinical, clinical, and translational studies to understand the mechanisms underlying the development of irAEs, determine their possible association with treatment outcomes, identify predictors of toxicity, determine the risk for infections and temporal relationship between use of ICPis and onset of infection, and evaluate the role of prophylactic vaccination and antimicrobial therapy |
| 6 | Including high-risk patients | Conduct prospective studies to evaluate safety and efficacy of immune checkpoint inhibitors in special populations with history of primary or secondary immune deficiencies, autoimmune diseases, stem cell or solid organ transplantation, HIV, hepatitis B or C, or prior irAEs |
| Include translational studies to identify immune markers that predict response and risk for irAEs | ||
| Discuss the increased risk associated with immune checkpoint blockade with the patient and caregivers prior to initiation of therapy | ||
| Optimize the choice, dosing, and duration of immunosuppressants to provide chronic immunosuppression without negating the benefits of immune checkpoint inhibitors | ||
| Develop specific guidelines for use of immune checkpoint inhibitors in high-risk patients | ||
| Establish a national registry of high-risk patients with cancer treated with ICPis | ||
| 7 | Incorporating diagnostic tools to personalize irAE management | Identify markers to predict risk for irAEs |
| Develop tools to monitor patients for emergence of irAEs | ||
| Validate the immune markers and clinical tools in large, prospective studies for reliability and generalizability | ||
| 8 | Using wireless technology and digital health | Efficiently use wireless technology and digital resources such as IO Tox Management app to equip healthcare providers |
| Use smartphone-based apps to monitor patients for warning symptoms that indicate impending emergence of irAEs | ||
| Institute prompt intervention based on collected information | ||
| 9 | Providing a platform to hear the missing patient’s voice | Monitor longitudinal changes in symptoms using a validated symptom assessment tool such as the MD Anderson Symptom Inventory for early detection of irAEs |
| 10 | Sharing evolving data | Disseminate the results of clinical and translational studies to the scientific community in a timely manner |
CTCAE, Common Terminology Criteria for Adverse Events; SITC, Society for Immunotherapy of Cancer.