Immune-Related Adverse Events From Immunotherapy: Incorporating Care Step Pathways to Improve Management Across Tumor Types

Abstract

Immune checkpoint inhibitor (ICI) therapy provides a valuable treatment option for many cancer patients but is associated with immune-related adverse events (irAEs) that can involve any organ system. Managing irAEs can be a challenge, as these AEs differ from those associated with conventional chemotherapy in both appearance and care. Prompt and successful irAE management is important for patient health and the maintenance of effective therapy. A group of advanced practice providers has developed Care Step Pathways (CSPs) to improve the management of irAEs (see Appendix and aimwithimmunotherapy.org ). These CSPs, which combine established guidelines with practical experience, provide information on assessing, grading, and managing irAEs. Proactive strategies, implementation tactics, patient education points, and “red flags” are also featured. This article provides a brief summary of ICI therapies currently used in oncology and an overview of irAEs that may occur during treatment. The importance of medication reconciliation and a thorough baseline assessment is stressed, and detailed information on baseline clinical and laboratory tests is provided. Specific CSPs for several irAEs, such as gastrointestinal toxicity, adrenal insufficiency, nephritis, and neuropathy, are reviewed in detail. As these CSPs illustrate, advanced practice providers are well positioned to play a key role in collaborative care for oncology patients, particularly with respect to providing in-depth patient education and “owning” AE management.

Optimizing Inpatient Care for Lung Cancer Patients with Immune Checkpoint Inhibitor- Related Pneumonitis Using a Clinical Care Pathway Algorithm

“…The algorithm integrates established guidelines with practical experience, providing information on assessing, grading, and managing ICI-P 22 . It also includes a process for triaging patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as the algorithm was developed during the global coronavirus disease 19 (COVID-19) pandemic 23 . The objectives of this clinical care pathway algorithm were to increase the awareness and recognition of ICI-P, facilitate timely diagnosis and treatment, activate a multidisciplinary team for the care of patients with ICI-P, and ensure adequate follow-up after hospital discharge, ultimately leading to better patient outcomes and reduced variations in patient care 24 .…”