title: Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper.
abstract: Monoclonal antibodies targeted against the immune checkpoint molecules CTLA-4 and PD-1 have recently obtained approval for the treatment of metastatic melanoma and advanced/refractory non small-cell lung cancers. Therefore, their use will not be limited anymore to selected hospitals involved in clinical trials. Indeed, they will be routinely prescribed in many cancer centers across the world. Besides their efficacy profile, these immune targeted agents also generate immune-related adverse events (irAEs). This new family of dysimmune toxicities remains largely unknown to the broad oncology community. Although severe irAEs remain rare (∼10% of cases under monotherapy), they can become life-threatening if not anticipated and managed appropriately. Over the last 5 years, Gustave Roussy has accumulated a significant experience in the prescription of immune checkpoint blockade (ICB) antibodies and the management of their toxicities. Together with the collaboration of Gustave Roussy's network of organ specialists with expertise in irAEs, we propose here some practical guidelines for the oncologist to help in the clinical care of patients under ICB immunotherapy.
authors.affiliation: Department of Drug Development (DITEP), Gustave Roussy Inserm U981, Univ. Paris-Sud, Université Paris-Saclay, Villejuif.
authors.forename: S
authors.initials: S
authors.lastname: Champiat
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Bicêtre, Le Kremlin Bicêtre Université Paris Sud 11, Le Kremlin-Bicêtre CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Fontenay-aux-Roses INSERM, U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre.
authors.forename: O
authors.initials: O
authors.lastname: Lambotte
authors.affiliation: Department of Ophthalmology, Hôpital Universitaire Bicêtre, Le Kremlin Bicêtre.
authors.forename: E
authors.initials: E
authors.lastname: Barreau
authors.affiliation: Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre.
authors.forename: R
authors.initials: R
authors.lastname: Belkhir
authors.affiliation: Department of Nuclear Medicine and Endocrine Tumors, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif.
authors.forename: A
authors.initials: A
authors.lastname: Berdelou
authors.affiliation: Gastroenterology Unit, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre.
authors.forename: F
authors.initials: F
authors.lastname: Carbonnel
authors.affiliation: Division of Adult Neurology, Hôpital Universitaire Bicêtre, Le Kremlin Bicêtre.
authors.forename: C
authors.initials: C
authors.lastname: Cauquil
authors.affiliation: Faculty of Medicine, Université Paris-Saclay, Univ Paris-Sud, Paris-Sud, UMR-S1185, Le Kremlin Bicêtre Unit of Endocrinology and reproductive Health, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin Bicêtre Unit of Gastroenterology, Institut National de la Santé et de la Recherche Médicale U1185 (P.C.), Le Kremlin Bicêtre.
authors.forename: P
authors.initials: P
authors.lastname: Chanson
authors.affiliation: Gastroenterology Unit, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre.
authors.forename: M
authors.initials: M
authors.lastname: Collins
authors.affiliation: Department of Nephrology and Transplantation, Bicêtre Hospital, Paris Saclay University, INSERM 1197, Le Kremlin Bicêtre.
authors.forename: A
authors.initials: A
authors.lastname: Durrbach
authors.affiliation: Department of Cardiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University [UPMC], Paris-Sorbonne, Paris.
authors.forename: S
authors.initials: S
authors.lastname: Ederhy
authors.affiliation: Department of Thoracic and cardiovascular, and transplantation cardio-pulmonary, Hôpital Marie-Lannelongue, Le Plessis-Robinson Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre.
authors.forename: S
authors.initials: S
authors.lastname: Feuillet
authors.affiliation: Department of Nephrology and Transplantation, Bicêtre Hospital, Paris Saclay University, INSERM 1197, Le Kremlin Bicêtre.
authors.forename: H
authors.initials: H
authors.lastname: François
authors.affiliation: Hematology Unit, Department of Medical Oncology, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif.
authors.forename: J
authors.initials: J
authors.lastname: Lazarovici
authors.affiliation: Department of Thoracic and cardiovascular, and transplantation cardio-pulmonary, Hôpital Marie-Lannelongue, Le Plessis-Robinson Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre UMR_S 999, Univ. Paris-Sud; INSERM; Hôpital Marie Lannelongue, Le Plessis Robinson.
authors.forename: J
authors.initials: J
authors.lastname: Le Pavec
authors.affiliation: Centre Hépato-Biliaire, AP-HP, Hôpital Universitaire Paul Brousse Inserm U1193.
authors.forename: E
authors.initials: E
authors.lastname: De Martin
authors.affiliation: Dermatology Unit, Department of Medical Oncology, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif.
authors.forename: C
authors.initials: C
authors.lastname: Mateus
authors.affiliation: Department of Drug Development (DITEP), Gustave Roussy.
authors.forename: J-M
authors.initials: JM
authors.lastname: Michot
authors.affiliation: Centre Hépato-Biliaire, AP-HP, Hôpital Universitaire Paul Brousse Inserm U1193.
authors.forename: D
authors.initials: D
authors.lastname: Samuel
authors.affiliation: Department of Drug Development (DITEP), Gustave Roussy Inserm U981, Univ. Paris-Sud, Université Paris-Saclay, Villejuif.
authors.forename: J-C
authors.initials: JC
authors.lastname: Soria
authors.affiliation: Inserm U981, Univ. Paris-Sud, Université Paris-Saclay, Villejuif Dermatology Unit, Department of Medical Oncology, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, Villejuif.
authors.forename: C
authors.initials: C
authors.lastname: Robert
authors.affiliation: Gustave Roussy Cancer Campus, Villejuif.
authors.forename: A
authors.initials: A
authors.lastname: Eggermont
authors.affiliation: Department of Drug Development (DITEP), Gustave Roussy Gustave Roussy Cancer Campus, Villejuif Inserm 1015, Univ. Paris-Sud, Université Paris-Saclay, Villejuif, France aurelien.marabelle@gustaveroussy.fr.
authors.forename: A
authors.initials: A
authors.lastname: Marabelle
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D060908:CTLA-4 Antigen / Q000276:immunology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000276:immunology; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions / Q000473:pathology; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D008545:Melanoma / Q000188:drug therapy* / Q000276:immunology; D061026:Programmed Cell Death 1 Receptor / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor
keywords: immunotherapy; medical oncology; neoplasms; practice guideline; toxicity