How do I monitor patients on immunotherapy for potential adverse effects, and when should I escalate care?

Patients receiving immunotherapy should be closely monitored for immune-related adverse events (irAEs) through regular clinical assessments and patient education to promptly identify symptoms affecting any organ system, including skin, gastrointestinal tract, endocrine glands, liver, and lungs. Monitoring should include baseline and periodic laboratory tests such as liver function tests, thyroid function tests, and inflammatory markers, alongside symptom review at each visit. Escalation of care is warranted if patients develop moderate to severe symptoms (e.g., grade 2 or higher toxicity), such as persistent diarrhea, severe rash, respiratory symptoms, or signs of endocrinopathy, which may require immunotherapy interruption and initiation of corticosteroids or other immunosuppressants. Immediate referral to specialist care is indicated for life-threatening or rapidly progressing irAEs, including severe pneumonitis, myocarditis, or neurological symptoms. Early multidisciplinary involvement, including oncology, rheumatology, and other relevant specialties, is essential for optimal management. Patient education on symptom recognition and prompt reporting is critical to timely intervention and minimizing morbidity.

This approach aligns with UK clinical practice emphasizing vigilant monitoring and timely escalation based on symptom severity and organ involvement NICE CG134, while recent EULAR guidance highlights the importance of rheumatological assessment for musculoskeletal irAEs and supports multidisciplinary management strategies Kostine et al. 2021.