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ICI Long-term Survivorship — SCE Medical Oncology MCQ

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HardLung CancerICI Long-term SurvivorshipSCE Medical Oncology

A 72-year-old man with stage IV NSCLC has achieved a durable complete response on pembrolizumab for 3 years. His oncologist discusses survivorship. What specific late effects of long-term checkpoint inhibitor therapy require monitoring?

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Correct answer: C — Late-onset irAEs (including endocrinopathies that may emerge months-years after ICI cessation), cardiovascular disease (accelerated atherosclerosis from chronic immune activation), secondary autoimmune conditions and late-onset pneumonitis all require ongoing surveillance

Long-term ICI survivorship is an emerging field. Late/delayed irAEs can occur months to years after ICI, including: new-onset endocrinopathies (hypothyroidism, hypophysitis), late pneumonitis, and de novo autoimmune conditions. There is emerging concern about accelerated atherosclerosis from chronic T-cell activation (Drobni et al Lancet 2020 — 3× increased cardiovascular event risk). Lifelong thyroid function monitoring is recommended. Structured survivorship plans incorporating irAE vigilance are increasingly important.

Reference: ESMO 2024 irAE and Survivorship; Drobni et al Lancet 2020; Johnson et al NEJM 2022