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Treatment
Table 11. Systemic Toxicities
11.1 Infusion-related Reactions (IRRs)
Workup/Evaluation
• Physical exam including vital signs
• Pulse oximetry
• ECG if chest pain or sustained tachycardia
Grading Management
G1: Mild transient reaction;
infusion interruption not
indicated; intervention not
indicated
• Continue ICPi.
• May consider premedication with acetaminophen
and an antihistamine for subsequent infusions.
G2: erapy or infusion
interruption indicated
but responds promptly to
symptomatic treatment;
prophylactic medication indicated
for less than or equal to 24 hours
• Consider holding ICPi temporarily and/or
reducing the rate of infusion to 50%.
• Symptomatic treatment with antihistamines,
NSAIDs, opioids, intravenous fluids as
appropriate.
• Prophylactic acetaminophen and an
antihistamine per institution guidelines
indicated for subsequent infusions.
G3: Prolonged (e.g., not rapidly
responsive to symptomatic
medication and/or brief
interruption of infusion);
recurrence of symptoms
following initial improvement;
hospitalization indicated for
other clinical sequelae
• Hold ICPi temporarily and consider resuming,
at an infusion rate of 50%, once return to ≤G1.
• Symptomatic treatment with antihistamines,
NSAIDs, opioids, intravenous fluids as
appropriate.
• Consider antihistamines and corticosteroid
medications intravenously.
• Hospitalization for other clinical sequelae.
G4: Life-threatening
consequences; urgent intervention
indicated
• Permanently discontinue ICPi.
• ICU level inpatient care.
Additional considerations:
• Clinicians may consider switching to an alternate agent in the therapeutic class upon
rechallenge or consider rechallenging with the offending immunotherapy agent
through a desensitization procedure under the supervision of an allergist.
