Weber, J.S. (2012). Practical management of immune-related adverse events from immune checkpoint protein antibodies for the oncologist. American Society of Clinical Oncology Educational Book, 174–177.
DOI Link
Purpose & Patient Population
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Expert opinion
DATABASES USED: Not included
INCLUSION CRITERIA: Patients treated with ipilimumab
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Results Provided in the Reference
Low grade diarrhea (grade 1) should be treated symptomatically using loperamide, oral hydration, and electrolyte substitution. A colitis diet is recommended. Persistent or higher-grade diarrhea, bacterial or parasitic infections, viral gastroenteritis, or the first manifestation of an inflammatory bowel disease should be ruled out by an exam. Oral diphenoxylate hydrochloride and atropine sulfate four times a day and budesonide 9 mg daily are recommended. An endoscopy is recommended. For grade 3 or 4 diarrhea, treatment with ipilimumab should be permanently discontinued, and IV steroids and replenishment of fluid and electrolytes IV should be administered.
Guidelines & Recommendations
Limitations
The information included was recommended in 2012. Since then, much more has been learned about the treatment of immune-related side effects of checkpoint inhibitors. Steroids are started early. This information seems out of date, and a more recent publication should be used for this specific type of side effect (immune-related colitis).
Nursing Implications
Patients who receive checkpoint inhibitors experience immune-related side effects that require immune suppression to manage. This is different from the management of diarrhea caused by other treatments for cancer. Nurses need to be aware of this specific cause of similar symptoms and be knowledgeable about its management.