teroids should be used on an individualized basis, depending
on medical history, co-morbidities, underlying
disease status, type and number of adverse events and
ability to tolerate corticosteroids. Keeping in mind that
depending on severity of ir-AE a prolonged taper of corticosteroids
may be required, which should be factored
into decisions to delay or withhold treatment. In general,
immune therapy should be held until steroids are nearing
a physiologic level, both to avoid recurrence of symptoms,
and to apply the agents in a physiologic setting
where they can be effective. The SITC guidelines contain
specific recommendations for each AE and should be consulted
for specific management strategies.26
Conclusion
The treatment algorithm for advanced RCC has undergone
dramatic changes with the introduction of immune
checkpoint blockade, thus mandating more attention to
the risk of adverse effects related to the expanding use of
immune checkpoint inhibitors. Comprehensive guidelines
from several international groups represent a benchmark
in how these ir-AE can be managed. Involvement by
a multi-disciplinary team of specialists is one of the cornerstones
of management highlighted by each set of
guidelines. One of the gaps in our understanding remains
the need for more information on the pathophysiology of
these untoward effects. As future studies unravel more details
on this issue, clinicians may obtain more clues on
how to prevent and minimize adverse reactions to a therapy
that has revolutionized RCC care.
Acknowledgements
The authors would like to acknowledge support for mentored
education from the NIH: K24CA172355 (WKR), and
the generous support of the Carol O’Hare fellowship (KEB).
Conflict of Interest
Research support to the institution of WKR is provided
for contracted clinical research studies from: Merck,
Pfizer, Bristol-Myers Squibb, Roche/Genentech, Incyte,
Calithera, Peloton, and Tracon.
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