Breaking: ASCO, NCCN Release Clinical Guidelines for Managing Immunotherapy-Related Toxicities
The American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have collaborated for the first time to release new clinical guidelines for managing immunotherapy-related toxicities.
Immunotherapy is revolutionizing treatment for many different types of cancers. However, these treatments may lead to side effects that are different and more complex than those resulting from chemotherapy. Few clinicians are experienced in recognizing and treating these toxicities.
New guidelines developed collaboratively by ASCO and NCCN provide clinicians with recommendations for the assessment and management of side effects related to immune checkpoint inhibitors.
“These new guidelines from ASCO and NCCN will help our community continue to provide the highest quality of care to all patients as they incorporate these agents into routine care,” said Clifford A Hudis, MD, FASCO, FACP, chief executive officer, ASCO, in a press release (January 14, 2018).
ASCO and NCCN convened multidisciplinary panels to develop the guidelines, including representation from medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, urology, neurology, hematology, emergency medicine, and nursing, as well as patient advocacy experts. The guidelines are based on systematic review of the literature and an informal consensus process.
Key guideline recommendations include:
· In general, immune checkpoint inhibitors can be continued with close monitoring for mild (grade 1) toxicities, with the exception of neurologic and some hematologic toxicities.
· For moderate (grade 2) toxicities, checkpoint inhibitors should be held until symptoms and/or lab values revert to grade 1 levels or lower. Corticosteroids may be offered.
· For severe (grade 3) toxicity, patients should receive high-dose corticosteroids for at least 6 weeks. Extreme caution when restarting immunotherapy after a grade 3 toxicity is recommended, if it is restarted at all.
· In general, very severe (grade 4) toxicity necessitates stopping checkpoint inhibitor therapy permanently.
· Consult the guidelines directly for more specific recommendations depending on which organ is affected.
Importantly, the panel noted that these guidelines pertain only to immune checkpoint inhibitors, not to other types of immunotherapy. NCCN will update the guidelines as data evolves, especially in regard to CAR-T therapy-related toxicities.—Zachary Bessette