Managing Checkpoint Inhibitor Symptoms and Toxicity for Metastatic Melanoma

Abstract

Immune-related adverse events (irAEs) are the most common toxicities observed in patients with melanoma receiving immune checkpoint blockade (ICB). They are mechanism-based side effects which most often occur within the first 12 weeks of therapy with ICB but can occur with chronic usage of these drugs over 1–2 years. Virtually any organ system can be involved, yet certain patterns of organ toxicity predominate, primarily targeting the skin, endocrine, liver, and GI systems. These irAEs are predominantly low grade and tend to resolve quickly with the use of steroids or other immunosuppressants. Toxicity can mimic common autoimmune conditions but have distinct kinetics of onset and resolution with appropriate therapy. Rapid recognition, close communication between the patient and the care team, and aggressive intervention with immunosuppressants are the key to successful management of these side effects.