NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Oncology

Medicines Update Oncology June 2017

NEW: Guideline for the Management of Immune-related Adverse Events


The West of Scotland Cancer Network (WOSCaN) Guidelines for Management of Immune-related Adverse Events have recently been issued by the West of Scotland Cancer Network and approved within NHS GGC.  These guidelines are available on the WOSCAN intranet site and on the GGC Clinical Guidelines directory on StaffNet. 

The guidance has been developed by the Beatson West of Scotland Cancer Centre Immuno-oncology subgroup in conjunction with non-cancer specialists. It aims to ensure that all those involved in the delivery of immunotherapy and the management of immune related adverse events has the appropriate knowledge and resources to deliver these treatments safely through the provision of standardised treatment algorithms for toxicity management.

Key points:

  • Immune checkpoint inhibitors (e.g. ipilmumab, nivolumab, pembrolizumab)  are associated with a unique spectrum of adverse effects termed 'Immune related adverse events (IrAE's)'.
  • IrAE's include, but are not limited to, pneumonitis, diarrhoea/colitis, hepatitis, nephritis / renal dysfunction, endocrinopathies and rash.
  • Appropriate management of IrAE's is essential to minimse the risk of severe toxicity and enable treatment to be continued, where appropriate, maximising the potential benefits of treament.
  • Patients receiving immunotherapy must receive information on the potential adverse effects which may occur during treatment or weeks to months after their last dose.  Patients should be given written information including an alert card and contact details for the Cancer Treatment Helpline.
  • Written information should be provided to alert GP that patient has been started on an immunotherapy with a link to the IrAE guideline.
  • Early identification of adverse events and timely management are critical to effective management.
  • The majority of IrAE's improve or resolve with appropriate management, including interruptions of treatment and administration of corticosteroids / supportive treatment.
  • Long term hormone replacement therapy may be necessary in cases of irreversible immune related endocrinopathies.
  • Regular communication between patients, carers and the clinical team is pivotal in the successful management of IrAE's.