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Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-mediated cardiovascular, rheumatic, and renal toxicities from checkpoint inhibitors

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Abstract

Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Although they are of variable occurrence, cardiovascular, rheumatic, and renal immune-mediated toxicities are among the most serious of these adverse events. We present MASCC recommendations with respect to the workup and management of cardiovascular, rheumatic, and renal immune-mediated toxicities with a focus on presentations that require treatment with immunomodulating agents.

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Acknowledgments

Professor BL Rapoport is supported by supported by the Cancer Association of South Africa (CANSA) and the National Research Foundation (NRF) of South Africa. Dr. I. Glezerman is supported by the NIH/NCI (Cancer Center Support Grant P30 CA008748).

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Authors and Affiliations

  1. Sections of Health Services Research and Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Maria E. Suarez-Almazor

  2. Section of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Xerxes Pundole & Noha Abdel-Wahab

  3. Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, USA

    Douglas B. Johnson

  4. Cardiology Division, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Dipti Gupta

  5. Renal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ilya Glezerman

  6. The Christie, Manchester, UK

    Tim Cooksley

  7. Faculty of Health Sciences, Department of Immunology, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa

    Ronald Anderson & Bernardo L. Rapoport

  8. Laboratory of Immunopathology, Institute of Biology and Experimental Medicine-CONICET, Buenos Aires, Argentina

    Ada Blidner

  9. Division of Oncodermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jennifer Choi

  10. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Michael Dougan

  11. Oncology Nursing Society, Pittsburgh, PA, USA

    Pamela Ginex

  12. Endocrine Division, Department of Medicine, Weill Cornell Medical College (MG, AF), New York, NY, USA

    Monica Girotra

  13. Department of Medicine (DJB), Memorial Sloan-Kettering Cancer Center (MC), New York, NY, USA

    Monica Girotra

  14. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vickie R. Shannon

  15. The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, Johannesburg, 2196, South Africa

    Bernardo L. Rapoport

  16. Department of Immunology, Faculty of Health Sciences, University of Pretoria, PO Box 667, Pretoria, 0001, South Africa

    Bernardo L. Rapoport

Authors
  1. Maria E. Suarez-Almazor
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  2. Xerxes Pundole
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  3. Noha Abdel-Wahab
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  15. Bernardo L. Rapoport
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Contributions

All of the authors contributed equally to the conceptualization of the manuscript; MES-A, XP, NA-W, DBJ, IG, and TC shared sections on rheumatic immune-related adverse events equally, while BLR and DBJ provided clinical input and BLR, DBJ, and RA editorial oversight. All of the authors provided critical appraisal of the manuscript and approve of its submission.

Corresponding author

Correspondence to Bernardo L. Rapoport.

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Conflict of interest

AW, XP, AB, RA, JC, TC, PG, DG RAG, and VRS have no conflict of interest to declare. MD reports grants from Novartis, other (SAB) from Neoleukin Therapeutics, personal fees from Partner Therapeutics, personal fees from Tillotts Pharma, and grants from Genentech, outside the submitted work. MG reports consultant work with Bristol Myers Squibb (BMS), and AstraZeneca, outside the submitted work. IG reports other (Stock Ownership) from Pfizer Inc., and personal fees from CytomX Inc., outside the submitted work. DBJ reports other (advisory board) from Array Biopharma, grants and other (advisory board) from BMS, other (advisory board) from Jansen, grants from Incyte, other (advisory board) from Merck, and other (advisory board) from Novartis, outside the submitted work. In addition, DBJ has a patent co-inventor on use of CTLA-4 agonist for IAEs pending. BLR reports personal fees and other (advisory board) from Merck and Co.; grants, personal fees, and other (advisory board) from BMS; grants, personal fees, and other (advisory board) from Roche South Africa; and personal fees and other (advisory board) from AstraZeneca, during the conduct of the study. MSA reports personal fees from Gilead, grants from Pfizer, and personal fees from Abbvie, outside the submitted work.

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Suarez-Almazor, M.E., Pundole, X., Abdel-Wahab, N. et al. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-mediated cardiovascular, rheumatic, and renal toxicities from checkpoint inhibitors. Support Care Cancer 28, 6159–6173 (2020). https://doi.org/10.1007/s00520-020-05710-8

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