Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management
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SPECIAL ARTICLE
Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-mediated cardiovascular, rheumatic, and renal toxicities from checkpoint inhibitors Maria E. Suarez-Almazor 1 & Xerxes Pundole 2 & Noha Abdel-Wahab 2 & Douglas B. Johnson 3 & Dipti Gupta 4 & Ilya Glezerman 5 & Tim Cooksley 6 & Ronald Anderson 7 & Ada Blidner 8 & Jennifer Choi 9 & Michael Dougan 10 & Pamela Ginex 11 & Monica Girotra 12,13 & Vickie R. Shannon 14 & Bernardo L. Rapoport 7,15,16 Received: 24 April 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Although they are of variable occurrence, cardiovascular, rheumatic, and renal immune-mediated toxicities are among the most serious of these adverse events. We present MASCC recommendations with respect to the workup and management of cardiovascular, rheumatic, and renal immune-mediated toxicities with a focus on presentations that require treatment with immunomodulating agents. Keywords Arthralgia . Arthritis . Cardiomyopathy . Corticosteroids . Myocarditis . Myositis . Immunomodulation agents . Other immunosuppressive agents . Polymyalgia
Introduction Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment [1]. Now approved in 16
* Bernardo L. Rapoport bernardo.rapoport@up.ac.za
different cancer types, these therapeutics may produce durable responses lasting for years in a subset of patients. Approved agents include those targeting programmed death-1 and its ligand (PD-1 and PD-L1) and cytotoxic T lymphocyte–
Ronald Anderson ronald.anderson@up.ac.za
Maria E. Suarez-Almazor msalmazor@mdanderson.org
Ada Blidner adablidner@gmail.com
Xerxes Pundole XNPundole@mdanderson.org
Jennifer Choi jennifer.choi@northwestern.edu
Noha Abdel-Wahab NAHassan@mdanderson.org
Michael Dougan mldougan@partners.org
Douglas B. Johnson douglas.b.johnson@vumc.org Dipti Gupta guptad@mskcc.org Ilya Glezerman Glezermi@mskcc.org Tim Cooksley cooks199@hotmail.com
Pamela Ginex pginex@ons.org Monica Girotra girotram@mskcc.org Vickie R. Shannon vshannon@mdanderson.org Extended author information available on the last page of the article
Support Care Cancer
associated antigen-4 (CTLA-4). Combinations of anti-PD-1/ PD-L1 with anti-CTLA-4 further augment immune responses and enhance clinical activity, but also increase the risk of toxicities. Toxicities from ICIs are known as immune-related adverse events (IrAEs). These events result from a loss of selftolerance when these key nodes of immune tolerance are pharmacologically inhibited [2, 3]. IrAEs may affect essentially any organ system, and range from mildly symptomatic to fulminant and fatal [4, 5]. In this section of the review
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