William Osler Health System, Brampton, ON L6R 3J7, Canada.
Women's College Hospital Research Institute, Toronto, ON M5S 1B2, Canada.
Curr Oncol. 2024 Oct 18;31(10):6356-6383. doi: 10.3390/curroncol31100473.
The increased use of immune checkpoint inhibitors (ICIs) across cancer programs has created the need for standardized monitoring and management of immune-related adverse events (irAEs). Delayed recognition without appropriate treatment can have serious and life-threatening consequences. The management of irAEs presents a unique set of challenges that must be addressed at a multidisciplinary level. Although various national and international guidelines and working groups provide high-level recommendations for the management of irAEs, practical guidance is lacking. Furthermore, timely collaboration between specialists requires institutional protocols that enable the early recognition, assessment, and treatment of irAEs. Such protocols should be developed by institution specialists and include algorithms for all healthcare providers involved in the care of patients treated with ICIs. At William Osler Health System in Brampton, Ontario, practical step-by-step multidisciplinary treatment approaches with recommendations for the management of irAEs were developed in collaboration with experts across Canada. Here, we provide an in-depth description of the approaches, outlining baseline investigations prior to the initiation of ICIs, as well as the monitoring and management of irAEs based on symptoms, severity, and involved organ systems. We encourage other centres to adapt and modify our approaches according to their specific needs and requirements.
免疫检查点抑制剂（ICIs）在癌症治疗中的广泛应用，使得对免疫相关不良反应（irAEs）进行标准化监测和管理成为必要。如果不能及时识别并进行适当治疗，可能会导致严重的、危及生命的后果。irAEs 的管理带来了一系列独特的挑战，必须在多学科层面上加以解决。虽然各种国家和国际指南和工作组为 irAEs 的管理提供了高级别的建议，但缺乏实际指导。此外，专家之间的及时协作需要机构协议，以便能够早期识别、评估和治疗 irAEs。这些协议应由机构专家制定，并包括参与治疗接受 ICI 治疗的患者的所有医疗保健提供者的算法。在安大略省布兰普顿的威廉·奥瑟尔健康系统，我们与加拿大各地的专家合作，制定了实用的、循序渐进的多学科治疗方法，并为 irAEs 的管理提供了建议。在这里，我们详细描述了这些方法，包括在开始使用 ICI 之前的基线调查，以及根据症状、严重程度和涉及的器官系统对 irAEs 进行监测和管理。我们鼓励其他中心根据自己的具体需求和要求，对我们的方法进行改编和修改。
