According to the Toxicity Management in Immunotherapy: ESMO Clinical Practice Guidelines for Diagnosis, Treatment, and Follow-up and the NCCN Guidelines for the Management of Immunotherapy-Related Toxicity 2018.1 Edition, once an adverse reaction occurs with PD-1/PD-L1 inhibitor therapy, the severity of the adverse reaction first needs to be assessed, with grade 1 being mild, grade 2 being moderate, and grade 3 to 4 being severe, with different levels of The treatment of adverse reactions is detailed in the following table.
(Note: ICU, Intensive Care Unit; when Grade 2 adverse reactions are cutaneous and endocrine, discontinuation is not required)
| Severity of adverse reactions | level of care | Hormones | Other immunosuppressants | PD-1/PD-L1 inhibitors |
| Level 1 | Non-ambulatory | Non-ambulatory | Not recommended |
No need to discontinue medication |
| Grade 2 | Non-ambulatory | Local hormone therapy or systemic hormone therapy [oral, 0.5 mg/(kg.d) to 1 mg/(kg.d)] | Not recommended | Suspended |
| Level 3 | Hospitalization | Systemic hormone therapy [oral or intravenous 1 mg/(kg.d) to 2 mg/(kg.d)] | If symptoms do not resolve after 3 to 5 days of hormone therapy, use under specialist supervision | Discontinue and evaluate for reuse based on risk/benefit ratio after remission of adverse effects |
| Grade 4 | Hospitalization, ICU if necessary | Systemic hormone therapy, intravenous, 1 mg/(kg.d) to 2 mg/(kg.d) for 2 days, after which the dose may be tapered to 1 mg/(kg.d) (kg.d) | If symptoms do not resolve after 3 to 5 days of hormone therapy, use under specialist supervision | Discontinue permanently |
(Note: ICU, Intensive Care Unit; discontinuation not required when Grade 2 adverse reactions are cutaneous and endocrine)
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Provincial Lung Cancer Institute Dr. Wang Zhen, Associate Chief Physician Xue-Tao Lai