How can I identify and manage common toxicities associated with immunotherapy in my practice?

In clinical practice, identifying and managing common toxicities associated with immunotherapy requires vigilance for immune-related adverse events (irAEs) that can affect multiple organ systems. Early recognition is critical, as these toxicities often mimic autoimmune conditions and can range from mild to life-threatening. Common toxicities include dermatologic reactions, colitis, pneumonitis, hepatitis, endocrinopathies, and ocular toxicities.

Identification: Patients receiving immunotherapy should be regularly monitored for new symptoms such as rash, diarrhea, cough, dyspnea, jaundice, fatigue, visual changes, or hormonal symptoms like polyuria or weight changes. Baseline and periodic laboratory tests including liver function, thyroid function, and inflammatory markers can aid early detection. Specific attention should be given to ocular symptoms, as immunotherapy and antibody-drug conjugates can cause ocular toxicities presenting with redness, pain, or vision changes Raheem et al. 2023.

Management: The cornerstone of managing immunotherapy toxicities is prompt assessment and grading of severity. Mild toxicities may be managed symptomatically with close monitoring, while moderate to severe toxicities often require immunotherapy interruption and initiation of corticosteroids or other immunosuppressants. For example, corticosteroids are first-line for immune-related colitis, pneumonitis, and hepatitis, with gradual tapering guided by clinical response Santomasso et al. 2021. Endocrinopathies such as hypothyroidism or adrenal insufficiency require hormone replacement rather than immunosuppression.

Multidisciplinary collaboration is essential, involving oncologists, endocrinologists, gastroenterologists, pulmonologists, and ophthalmologists as needed. Patient education on symptom reporting and timely follow-up is vital to prevent progression of toxicities. Emerging evidence supports tailored immunosuppressive strategies and highlights the importance of balancing toxicity management with maintaining immunotherapy efficacy Santomasso et al. 2021Raheem et al. 2023.