Nebenwirkungsmanagement bei Immuncheckpointinhibition

Immune checkpoint inhibitors (ICI) induce a (re)activation of the body’s immune system to fight malignant cells and constitute a fundamental pillar of contemporary cancer therapy. Despite their relatively good tolerability, the occurrence of severe, potentially life-threatening immune-related adverse events (irAE) poses a significant challenge.

Drawing upon a selective literature review and guideline adaptation, an interdisciplinary consensus-based and, where feasible, evidence-based German-language guideline recommendation for irAE management has been developed for the first time. Patient and caregiver education regarding irAE associated with ICI, along with measurement of defined laboratory parameters before and during ICI treatment, aims to facilitate the timely identification of irAE. In cases of suspected irAE ≥ grade 2, ICI treatment is typically temporarily halted, and organ-specific contextual and differential diagnostic tests are initiated. In addition, higher-grade irAE usually prompt an immediate therapeutic attempt with 1–2 mg of prednisolone/kg bodyweight. If there is a response of the irAE, a gradual prednisolone tapering over 4–8 weeks is often indicated. Absence of improvement within 72 h necessitates further investigation, often including histology, and may require an expansion of immunosuppressive treatment. Recurrent and chronic irAE typically demand advanced differential diagnostics and the use of steroid-sparing immunosuppressive (long-term) medication.

Vigilance, monitoring, prompt differential diagnostic categorization, and initiation of therapy are essential for optimal irAE management. In this regard, challenges persist with new ICI target molecules, combination therapies, and often insufficient evidence.