An Interactive Algorithm Tool Featuring NCCN Guidelines for the Management of Immune-Related Adverse Events for Patients Receiving Immune Checkpoint Inhibitors

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John A. Thompson, MD

Professor of Medicine
Division of Medical Oncology
University of Washington
Seattle, Washington



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Released: February 7, 2019

Immune checkpoint inhibitors are being integrated into the care of a rapidly increasing number of patients with a variety of tumor types. The toxicity profile of these agents is unique and requires a specific knowledge base for optimal identification and management. Immune-related adverse events (irAEs) most commonly affect the skin, gastrointestinal tract, and liver, and—to a lesser extent—the endocrine system, lungs, kidneys, joints, and central nervous system. Indeed, virtually any organ system can be affected. These irAEs reflect the immune-based mechanism of action of checkpoint inhibitors. Most grade 3/4 irAEs occur during the first 12-14 weeks of treatment and show a somewhat predictable pattern of onset with dermatologic events occurring first, followed by colitis, and then hepatitis and endocrinopathies occurring later in treatment; however, the onset kinetics can vary when these agents are combined with other therapies.

Effective irAE management allows for optimal treatment and mitigates potentially serious treatment-related complications. As such, it is critical that all members of the healthcare team are able to promptly recognize and appropriately treat these events. In February 2018, the National Comprehensive Cancer Network® (NCCN), together with ASCO, published consensus guidelines for the management of irAEs.

Now, Clinical Care Options, in partnership with the NCCN, has developed an interactive algorithm tool to help clinicians easily navigate the NCCN Guidelines®, allowing them quick access to case-specific guidance on irAE management for their unique patient scenarios. As a clinician, you are able to enter the organ system and severity or grade of your patient’s irAE into the tool (Figure 1).

Figure 1. Entering characteristics of your patient’s irAE into the tool.

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Once the information has been entered for your specific case scenario, you are then able to indicate your intended management plan. After entering your management plan, you will be shown the NCCN Guidelines for the specific organ system and severity of the event in your patient case, allowing you to compare the guidelines with your planned management (Figure 2).

Figure 2. NCCN Guidelines® recommendations.

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Through this approach, participants can quickly and easily access NCCN Guidelines recommendations, with additional considerations to aid in the management of their patient’s toxicity. The goal is to routinely update this online tool so that our recommendations include consideration of emerging data and newly available agents.

If you have any suggestions regarding this online tool, please be sure to leave a comment below.

Provided by the Annenberg Center for Health Sciences at Eisenhower
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Supported by an educational grant from
Bristol-Myers Squibb

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