Immune toxicity of checkpoint inhibitors
Baseline and monitoring tests before checkpoint inhibitors, a stepwise approach to the unwell patient, how to read LFT, thyroid, cortisol, troponin and stool results in suspected irAEs, organ-by-organ management by grade, and when to stop or rechallenge.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Immune-related adverse events (irAEs) can affect any organ. Skin, gut, liver, thyroid and lung are common; heart, nerve and muscle are rare but kill.
- Risk is highest with ipilimumab plus nivolumab (grade 3 to 4 events in over half), lower with PD-1 or PD-L1 monotherapy (about 15 to 20%). Mechanisms, timing and the grading table are in Cancer immunotherapy.
- Every new symptom on a checkpoint inhibitor is an irAE until shown otherwise, but infection and progression come first in the differential.
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Sources
- Safa H et al. Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature. J Immunother Cancer 2019;7:319Journal for ImmunoTherapy of Cancer, 2019
- eviQ: Immune-related adverse events associated with immune checkpoint inhibitors, and immunotherapy baseline and monitoring recommendationsAU/NZCancer Institute NSW, 2026
- Therapeutic Guidelines: Oncology (adverse effects of immunotherapy)AU/NZTherapeutic Guidelines Ltd
- Schneider BJ et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol 2021;39:4073-126American Society of Clinical Oncology, 2021 (current, November 2026)
- Haanen J et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline. Ann Oncol 2022;33:1217-38European Society for Medical Oncology, 2022 (current, November 2026)
- Brahmer JR et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021;9:e002435Society for Immunotherapy of Cancer, 2021
- Lyon AR et al. 2022 ESC Guidelines on cardio-oncology. Eur Heart J 2022;43:4229-361European Society of Cardiology, 2022 (current, November 2026)
- YERVOY (ipilimumab) prescribing information, dosage modifications for immune-mediated hepatitisBristol-Myers Squibb (US label, DailyMed), Checked November 2026
- Management of immune checkpoint inhibitor-associated toxicities in older adults with cancer: recommendations from the International Society of Geriatric Oncology (SIOG). Lancet Oncol 2025International Society of Geriatric Oncology, 2025
- Common Terminology Criteria for Adverse Events (CTCAE) v6.0US National Cancer Institute, 2025
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback