Table 1

Summary of the recommended strategies for effective management of immune-related adverse events (irAEs)

Action itemsRecommended strategies
1Providing patient educationUse 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
2Refining irAE management guidelinesConvene 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
3Standardizing reporting of irAEsIncorporate SITC CTCAE Task Force irAE-specific module into future versions of the CTCAE
4Optimizing the choice of immunosuppressive agentsConduct 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
5Pursuing better understanding of irAEsConduct 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
6Including high-risk patientsConduct 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
7Incorporating diagnostic tools to personalize irAE managementIdentify 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
8Using wireless technology and digital healthEfficiently 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
9Providing a platform to hear the missing patient’s voiceMonitor longitudinal changes in symptoms using a validated symptom assessment tool such as the MD Anderson Symptom Inventory for early detection of irAEs
10Sharing evolving dataDisseminate 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.