Get in the (Immuno)KNOW: A Guide to Immunotherapy Related Side Effects for the Hospitalist-Slides

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This guide provides hospitalists with essential knowledge for managing immune checkpoint inhibitor (ICI) therapy side effects—an increasingly common cancer treatment that harnesses the patient's immune system to target tumors. Unlike traditional chemotherapy, which kills rapidly dividing cells, immunotherapy "releases the brakes" on immune responses to enhance anti-tumor activity.<br /><br />Key learning objectives include understanding ICI mechanisms, distinguishing their side effects from chemotherapy, and managing common immune-related adverse events (irAEs), namely pneumonitis, colitis, and endocrinopathies.<br /><br />ICI-pneumonitis manifests as cough, hypoxia, chest pain, and fever, with variable imaging findings and usually bilateral lung involvement. It occurs in 3-19% of cases and can be life-threatening. Early pulmonary consultation and bronchoscopy are critical. Treatment depends on severity, ranging from ICI therapy hold and steroids for mild cases to hospitalization, high-dose IV steroids, and immunosuppressants for severe disease.<br /><br />Immune-mediated colitis presents with diarrhea, abdominal pain, and sometimes bloody stools. Infectious causes must be ruled out. Early gastroenterology involvement is advised. Management varies from close monitoring to steroid therapy and immunosuppressants (like infliximab) if refractory.<br /><br />Endocrinopathies, especially thyroid dysfunction and hypophysitis, require routine TSH and free T4 monitoring during ICI therapy. Presentations include fatigue, headache, hypotension, and altered mental status. Diagnosis involves hormone panels and pituitary MRI. Prompt endocrinology consultation and hormone replacement are key, often allowing continuation of immunotherapy with ongoing management.<br /><br />The guide emphasizes grading irAEs by severity to tailor treatment, utilizing steroids or other immunosuppressives appropriately. Multidisciplinary collaboration improves outcomes and safety.<br /><br />In conclusion, hospitalists must maintain high suspicion for irAEs in patients on ICIs, as timely recognition and evidence-based interventions are vital in reducing morbidity and mortality associated with these increasingly used cancer therapies.

Keywords

immune checkpoint inhibitor

ICI therapy

immune-related adverse events

irAEs

pneumonitis

colitis

endocrinopathies

immunotherapy side effects

steroids treatment

multidisciplinary management