Linardou, H., & Gogas, H. (2016). Toxicity management of immunotherapy for patients with metastatic melanoma. Annals of Translational Medicine, 4, 272.

DOI Link

Purpose & Patient Population

PURPOSE: To review the side effects of checkpoint inhibitors and their management
 
TYPES OF PATIENTS ADDRESSED: Adult patients with melanoma receiving checkpoint inhibitor therapy

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Expert opinion

 

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Guidelines & Recommendations

Skin: Rash reported in about 20% of patients in clinical trials. Suggests topical and/or oral steroid treatment for persistent or recurring grade 2 rash. Antihistamines suggested for pruritis. IV high-dose steroids (methylprednisolone 1–2 mg/kg/day) followed by oral steroids on improvement tapered over four weeks
 
Diarrhea: Most studies report diarrhea in at least 30% commonly presenting at about five weeks. Grade 1: Loperamide, antidiarrheal diet, hydration
 
Grade 2: Oral budesonide or other moderate corticosteroid, tapered over 30 days. 
 
Grade 3: High-dose IV steroids (e.g., methylprednisolone 1–2 mg/kg/day) tapering for at least one month. If no improvement occurs within one week, use anti-TNF inhibitors, remicade, or infliximab.
 

Limitations

Expert opinion level only. The evidence is derived only from initial drug clinical trials.

Nursing Implications

Limited research evidence regarding interventions to prevent and manage side effects of immunotherapies exists, and most relies on corticosteroid treatment with increased dosing according to the severity of the side effects. Nurses need to be aware that diarrhea, in particular, with immunotherapy can lead to severe colitis, which can be life-threatening and require surgical removal of the colon. Patients need to be taught to report side effects promptly, and patients need to be monitored closely for these adverse events, with prompt intervention.