Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group

Table 1 Pre-treatment evaluation and diagnostic tests to consider in all patients prior to initiating checkpoint inhibitor therapy

Routine pre-treatment screening
History ♦ Detailed questioning for autoimmune, infectious disease, endocrine and organ-specific disease history ♦ History of base line bowel habit (frequency of bowel movements, usual stool consistency) Blood tests ♦ CBC ♦ CMP ♦ TSH ♦ HbA1c ♦ Free T4 ♦ Total CK ♦ Infectious disease screen: HBsAg, HBsAb, HBcAb, hCAb, CMV antibody, T-spot test, HIV antibody, HIV antigen (p24)^a ♦ Fasting lipid profile Dermatologic examination ♦ Full skin and mucosal exam, taking note of the extent and type of lesions present Pulmonary tests ♦ Baseline oxygen saturation on room air and during ambulation Cardiac tests ♦ ECG ♦ Troponin I or T: baseline and weekly for 6 weeks^b
Additional screening tests recommended in patients with pre-existing organ disease/at risk of organ-specific toxicity
Endocrine tests ♦ 8 am cortisol ♦ 8 am ACTH Cardiac tests ♦ Brain natriuretic peptide (BNP) or N-terminal pro B-type natriuretic peptide (NT pro-BNP) Pulmonary tests ♦ PFTs^c ♦ 6MWT^c

In certain settings, some of these tests may not be readily available. Until their use is firmly supported by evidence, individual physician judgment is recommended
^aThese tests become very relevant if patients develop irAEs and require immunosuppressive treatment such as steroids and/or anti-TNFα treatment
^bGiven the rarity of cardiac toxicity, this may not be cost-effective as a routine test. . Baseline troponin should be measured although the follow up interval for re-testing is not determined. Any suspicious cardiopulmonary symptoms warrant repeat troponin and natriuretic testing in this population
^cGiven the rarity of pulmonary toxicity, pre-treatment PFTs and 6MWTs should considered in patients with pre-existing lung disease (chronic obstructive pulmonary disease, interstitial lung disease, sarcoidosis, pulmonary fibrosis etc.) and may not be feasible in all patients
ACTH, Adrenocorticotropic hormone; CBC, Complete blood count; CMP, Complete metabolic panel; CMV, Cytomegalovirus; CK, Creatine kinase; ECG, Electrocardiogram; HbA1c, Glycosylated hemoglobin; HBsAg, Hepatitis B surface antigen; HBsAb, Hepatitis B surface antibody; HBcAb, Hepatitis B core antibody; HCAb, Hepatitis C antibody; HIV, Human Immunodeficiency Virus; PFTs, Pulmonary function tests; TSH, Thyroid-stimulating hormone; T4, Thyroxine; 6MWT, 6 min walk test