價Check for updatesReceived:18 November 2022Accepted:19 March 2023D0t10.1002/jhm.13097Journal ofCLINICAL GUIDELINE HIGHLIGHTS FORHospital Medicinesh.THE HOSPITALISTClinical guideline highlights for the hospitalist:Managementof immune-related adverse events in patients treated withimmune checkpoint inhibitor therapySaurabh D.Chitnis MD,MS Amir Mortazavi MDDivision of Medical Oncology.Department ofInternal Medicine,The Ohio State UniversityGUIDELINE TITLE:Management of Immune-Related Adverse Events in PatientsComprehensive Cancer Center,Columbus,Ohio,USATreated with Immune Checkpoint Inhibitor Therapy:ASCO Guideline UpdateRELEASE DATE:November 1,2021CorrespondencePRIOR VERSION(S):February 14,2018Saurabh D.Chitnis,MD,MS,Division ofMedical Oncology,Department of IntemalDEVELOPER:American Society of Clinical OncologyMedicine,The Ohio State UniversityFUNDING SOURCE:American Society of Clinical OncologyComprehensive Cancer Center,Columbus,OH,USA.TARGET POPULATION:Adult patients with cancer receiving treatment withEmail:saurabhdchitnis@gmail.com;immune checkpoint blockade inhibitors aloneTwitter:@DrSDChitnisINTRODUCTIONall patients who received previous ICPi therapy.3 Hospitalists needto be trained to care for these patients,who have a wide variety ofThe advent of immunotherapy involving immune checkpoint inhibi-irAE presentations and higher mortality risk due to multiorgantors (ICPis)has dramatically altered the standard of care in treatinginvolvement.smany cancers.ICPi usage has increased tremendously in recent yearsThe 2021 American Society of Clinical Oncology (ASCO)updatedwith almost 40%of cancer patients in the United States in 2019guidelines to provide recommendations for the management of thesebeing eligible for ICPi treatment.1 Many new ICPi treatmentirAEs this article highlights the key recommendations that areregimens,individually and in combination therapies,across variousapplicable to hospitalists.tumor types have been developed and present new avenues incancer care.However,the use of ICPis is linked to myriad side effectsthat may involve any organ system of the body,due to theirKEY RECOMMENDATIONS FOR THEmechanism of action which disrupts intercellular signaling to allowHOSPITALISTTcells to recognize and attack cancer cells.Multiple factors related toindividual patients,type of cancer being treated and class of ICPiRecommendation 1:Patients and family caregivers should receiveaffect the incidence and onset of immune-related adverse eventstimely and up-to-date education about immunotherapies,their(irAEs).The onset of different irAEs varies from early occurrence-mechanism of action,and the clinical profile of possible irAEs beforewithin days of initial dose-to delayed onset-up to 26 weeks-with ainitiating therapy and throughout treatment and survivorship.median onset of approximately 40 days.Though mild presentationRecommendation 2:There should be a high level of suspicion that theof irAEs can be managed as outpatients,moderate to severe cases
