irAE Workup Guidelines

  June 26, 2024

Managing immune-related adverse events among patients who have received immune checkpoint inhibitors (ICI) can present many challenges for the multidisciplinary care team. Not only can irAEs be difficult to distinguish from other conditions, but knowing how and when to admit a patient, treat symptoms, or withhold ICI therapy can be difficult to navigate. However, in recent years, many organizations have published formal recommendations, or workup guidelines, for managing irAEs, including ASCO, ESMO, NCCN, and SITC.

The following can be used as a directory for the current irAE workup guidelines. Click to expand the organ system of interest to display the common irAEs for which guidelines are available, with details of where to find the condition-specific information in each set of guidelines. 

ASCO GUIDELINES (AS OF 2018):
Brahmer JR, Lacchetti C, Schneider BJ, Atkins MB, Brassil KJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2018;36(17):1714-1768 doi.org/10.1200/JCO.2017.77.6385

ESMO GUIDELINES (AS OF 2017):
Haanen JBAG, Carbonnel F, Robert C, Kerr KM, Peters S, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(S4): i119-i142. doi.org/10.1093/annonc/mdx225 

ESMO GUIDELINES CORRECTION (AS OF 2018):
Haanen JBAG, Carbonnel F, Robert C, Kerr KM, Peters S,  et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(S4): iv264-iv266. doi.org/10.1093/annonc/mdy162  

NCCN GUIDELINES (AS OF 2019):
Available on the NCCN website under NCCN Guidelines for Supportive Care, listed as Management of Immunotherapy-Related Toxicities. Login required; registration is free. https://www.nccn.org/ 

SITC GUIDELINES (AS OF 2017):
Puzanov I, Diab A, Abdallah K, Bingham CO 3rd, Brogdon C, et al. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J ImmunoTher Cancer. 2017;5(95). DOI 10.1186/s40425-017-0300-z