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

Support Care Cancer. 2020 Dec;28(12):6159-6173. doi: 10.1007/s00520-020-05710-8. Epub 2020 Aug 27.

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; Immunomodulation agents; Myocarditis; Myositis; Other immunosuppressive agents; Polymyalgia.

Publication types

  • Historical Article
  • Practice Guideline
  • Review

MeSH terms

  • CTLA-4 Antigen / antagonists & inhibitors
  • CTLA-4 Antigen / immunology
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / therapy*
  • Drug-Related Side Effects and Adverse Reactions / etiology
  • Drug-Related Side Effects and Adverse Reactions / therapy*
  • History, 21st Century
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects*
  • Immune Checkpoint Inhibitors / therapeutic use
  • Immunologic Factors / adverse effects
  • Immunologic Factors / therapeutic use
  • Immunotherapy / adverse effects*
  • International Agencies / organization & administration
  • International Agencies / standards
  • Kidney Diseases / chemically induced
  • Kidney Diseases / epidemiology
  • Kidney Diseases / therapy*
  • Neoplasms / epidemiology
  • Neoplasms / immunology
  • Neoplasms / therapy
  • Palliative Care / organization & administration
  • Palliative Care / standards
  • Palliative Medicine / organization & administration
  • Palliative Medicine / standards
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors
  • Programmed Cell Death 1 Receptor / immunology
  • Rheumatic Diseases / chemically induced
  • Rheumatic Diseases / epidemiology
  • Rheumatic Diseases / therapy*
  • Severity of Illness Index
  • Societies, Medical / organization & administration
  • Societies, Medical / standards

Substances

  • CTLA-4 Antigen
  • CTLA4 protein, human
  • Immune Checkpoint Inhibitors
  • Immunologic Factors
  • Programmed Cell Death 1 Receptor