Table 1.

Adverse events associated with immune-checkpoint blockade

Immune-mediated adverse event	Manifestations	Management
Enterocolitis	Diarrhoea, abdominal pain, mucus or blood in stool	Antidiarrhoeals followed by systemic corticosteroids if persistent; infliximab if refractory
Pneumonitis	Dyspnoea, cough	Systemic corticosteroids
Hepatitis	ALT/AST, bilirubin elevation	Systemic corticosteroids; mycophenolate mofetil if refractory
Dermatitis	Pruritic/macular/papular rash, Stevens–Johnson syndrome (rare), toxic epidermal necrolysis (rare)	Topical betamethasone or oral antihistamines; systemic corticosteroids if refractory
Neuropathy	Sensory/motor neuropathy, Guillain–Barre syndrome (rare), myasthenia gravis (rare)	Systemic corticosteroids
Endocrinopathy	Hypothyroidism, hyperthyroidism, hypopituitarism, adrenal insufficiency, hypogonadism, Cushing’s syndrome (rare)	Systemic corticosteroids, appropriate hormone replacement (potentially long-term)
Other irAEs	Arthritis, nephritis, meningitis, pericardidits, uveitis, iritis, anaemia, neutropenia	Organ-system specific

Severe immune-mediated adverse events require permanent discontinuation of therapy and initiation of high-dose systemic corticosteroids. Therapy should be withheld for moderate immune-mediated adverse events or symptomatic endocrinopathy. Non-immune aetiology should be ruled out when possible, and manufacturer recommendations should be reviewed for the latest guidance and dosing information. ALT, alanine aminotransferase; AST, aspartate aminotransferase; irAEs, immune-related adverse events.