65
Table 9. Cardiovascular Toxicities
G4: Life-threatening
consequences; hemodynamic
or neurologic instability; organ
damage; loss of extremity(ies).
• Hold ICPi and may reintroduce after risk/
benefit are considered.
• Admit patient and management according to
CHEST, ACC, and/or AHA guidelines and
with guidance from cardiolog y.
• Respiratory and hemodynamic support.
• Follow G2 anticoagulation recommendations
with further clinical management as indicated
based on symptoms.
Additional considerations:
• VTE prophylaxis in high-risk outpatients with cancer (Khorana score of 2 or higher
prior to starting a new systemic regimen) may be offered thromboprophylaxis with
apixaban, rivaroxaban, or LMWH provided there are no significant risk factors for
bleeding and no drug interactions, as per ASCO VTE guideline.
• While it may be impossible to determine the etiolog y of thromboembolic disease
in patients with advanced cancer and the role, if any, that ICPi treatment plays,
it is reasonable to remove the potential inciting agents given the severity and
life-threatening potential of Grade 4 complications. Clinicians are to use clinical
judgment and take into account the risks and benefits when deciding whether to
discontinue ICPi treatment.
• Anticoagulant therapy duration should continue while on immunotherapy
and consideration be given to continuing for an additional 6 months following
completion of immunotherapy.
(cont'd)
