ASCO GUIDELINES Bundle

Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy

ASCO GUIDELINES App Bundle brought to you fcourtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/1475468

Contents of this Issue

Navigation

Page 15 of 71

16 Treatment Table 1. Cutaneous Toxicities 1.1 Rash/Inflammatory Dermatitis Workup/Evaluation: • Pertinent history and physical exam including examination of the oral mucosa, assessment for blister formation, assessment of body surface area involved. • Review full list of patient medications to rule out other drug-induced cause for photosensitivity. • Rule out any other etiolog y of the skin problem, such as an infection, an effect of another drug, including prior or other recent cancer therapies, or a skin condition linked to another systemic disease or unrelated primary skin disorder. • Recent or new complete blood count and comprehensive metabolic panel (if needed for skin differential diagnosis). • Consider referral to dermatologist if autoimmune skin disease is suspected. • Consider skin biopsy. • Consider clinical monitoring with use of serial clinical photography. Grading Grading according to Common Terminolog y Criteria for Adverse Events (CTCAE) criteria is a challenge for skin. Instead, severity may be based on body surface area (BSA), tolerability, morbidity, and duration. Management G1: Rash covering <10% BSA, which may or may not be associated with symptoms of pruritus or tenderness. • Continue ICPi. • Treat with topical emollients and/or mild-moderate potency topical corticosteroids. • Counsel patients to avoid skin irritants. G2: Rash covering 10–30% BSA with or without symptoms (e.g., pruritus, burning, tightness); limiting instrumental activities of daily living (ADL); rash covering >30% BSA with or without mild symptoms. • Consider holding ICPi and monitor weekly for improvement. If skin toxicity not improved after 4 weeks, then re-grade toxicity as Grade 3. • In addition, treat with topical emollients, oral antihistamines, and medium-to-high potency topical corticosteroids. • Consider initiating prednisone (or equivalent) at dosing 0.5–1 mg/kg, tapering over 4 weeks. In patients with pruritis without rash, consider topical anti-itch remedies (e.g., refrigerated menthol, pramoxine).

Articles in this issue

Archives of this issue

view archives of ASCO GUIDELINES Bundle - Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy