PURPOSE: Review article
TYPES OF PATIENTS ADDRESSED: Programmed cell death protein 1 (PD-1) immune checkpoint pathway inhibitors/antibody adverse events reported on patients treated with these agents while participating in registry clinical trials, a retrospective review, and a consensus panel of above authors.
Skin events: Prevention and patient education. Topical glucocorticoids, urea-containing ointment, and oral antihistamines. Grade 3–4: hold checkpoint inhibitor, oral steroids with taper.
GI events: Assess for progressive disease or infection. Grade 1: Antidiarrheal medications, oral hydration, and electrolyte supplementation. Grade 2 or higher: Colonoscopy with biopsy. Grade 2 persistent diarrhea: 0.5–1 mg/kg/day methylprednisolone or equivalent. For grade 3: 1–2 mg/kg/day methylprednisolone or equivalent administered. Taper steroids over four weeks. Immune therapy may be resumed after glucocorticoid taper. Grade 4: Permanently discontinue immune therapy.
Dyspnea: Tests include pulmonary function tests, chest X-ray, CT scan, and arterial blood gas. Treat with steroids based on grade. Grade 2: 1 mg/kg/day methylprednisolone or equivalent; grade 3–4: 2–4 mg/kg/day methylprednisolone or equivalent. Based on response to steroids, additional immune suppressant therapy may be needed.