example, a decrease of hemoglobin value below laboratory normal values (13 and 12 g/l for men and women, respectively) is often minimized until it falls below 10 g/dl because oncologists usually reason according to classic transfusion threshold. In the case of patients treated by immunotherapies, oncologists should always consider patients on a case-by-case basis: patient's values at baseline are each patient's reference values. Alert for monitoring or exploration should be triggered according to baseline variations. Also physicians should be aware that irAE can slowly alter biological parameters over time and a decrease or increase of such parameters should be envisioned over multiple time points. In case of a nonsevere and nonspecific symptom, close monitoring should be conducted to evaluate its evolution and easily repeat proper laboratory or imaging tests. Treat Key Points of Immune-related Adverse Events Management Here are the key points to be handled when a patient is developing an irAE: close monitoring ambulatory versus inpatient care symptomatic treatment immunotherapy suspension or termination corticotherapy and associated measures immunosuppressive drugs patient information on how to self-monitor clinical elements The typical clinical management of irAEs is described in . Table 4. Typical management of irAEs Ambulatory Other versus Corticosteroids immunosuppressive Immunotherapy grade inpatient care drugs 1 Ambulatory Not recommended Not recommended Continue Topical steroids or Suspend 2 Ambulatory Systemic steroids Not recommended temporarilya oral 0.5–1 mg/kg/day To be considered for patients with Systemic steroids Suspend and unresolved Oral or i.v. discuss symptoms after 3–5 3 Hospitalization 1–2 mg/kg/day for resumption days of steroid 3 days then reduce on risk/benefit course to 1 mg/kg/day ratio with patient Organ Specialist referral advised Hospitalization Systemic steroids To be considered for Discontinue 4 consider i.v. patients with permanently
example, a decrease of hemoglobin value below laboratory normal values (13 and 12 g/l for men and women, respectively) is often minimized until it falls below 10 g/dl because oncologists usually reason according to classic transfusion threshold. In the case of patients treated by immunotherapies, oncologists should always consider patients on a case-by-case basis: patient's values at baseline are each patient's reference values. Alert for monitoring or exploration should be triggered according to baseline variations. Also physicians should be aware that irAE can slowly alter biological parameters over time and a decrease or increase of such parameters should be envisioned over multiple time points. In case of a nonsevere and nonspecific symptom, close monitoring should be conducted to evaluate its evolution and easily repeat proper laboratory or imaging tests. Treat Key Points of Immune-related Adverse Events Management Here are the key points to be handled when a patient is developing an irAE: close monitoring ambulatory versus inpatient care symptomatic treatment immunotherapy suspension or termination corticotherapy and associated measures immunosuppressive drugs patient information on how to self-monitor clinical elements The typical clinical management of irAEs is described in . Table 4. Typical management of irAEs grade Ambulatory versus inpatient care Corticosteroids Other immunosuppressive drugs Immunotherapy 1 Ambulatory Not recommended Not recommended Continue 2 Ambulatory Topical steroids or Systemic steroids oral 0.5–1 mg/kg/day Not recommended Suspend temporarilya 3 Hospitalization Systemic steroids Oral or i.v. 1–2 mg/kg/day for 3 days then reduce to 1 mg/kg/day To be considered for patients with unresolved symptoms after 3–5 days of steroid course Organ Specialist referral advised Suspend and discuss resumption on risk/benefit ratio with patient 4 Hospitalization consider Systemic steroids i.v. To be considered for patients with Discontinue permanently
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