Clinical tools for oncology professionals

Immunotherapy Toxicity Management Guideline Tool

This tool is adapted from ASCO and ESMO guidelines on immunotherapy toxicity management. Users should refer to the original publications of each guideline for full details. In a given patient, clinician judgement should be used when making management decisions.


Grade: Grade is as per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 unless stated otherwise.

Immunotherapy (Immune checkpoint inhibitor) toxicity management guideline tool

Immune checkpoint inhibitors of the anti-PD1 / PD-L1 and anti-CTLA4 class can be associated with a range of immune mediated toxicities. The management of such toxicities depends on the severity and type of toxicity encountered.

In an effort to provide standardised recommendations for the management of immunotherapy toxicities, the international societies ESMO (1) and ASCO (2) have produced immunotherapy toxicity management guidelines. Whilst the recommended approach is broadly similar between both guidelines, small differences exist and it may help clinicians to have reference to both guidelines.

The general approach to immunotherapy toxicity management involves: patient assessment and grading of toxicity, investigating for alternative causes, commencing immunosupression typically when the grade of toxicity is ≥ 2 or higher and re-assessing the patient after a suitable interval to determine need for treatment adaptation.

The ESMO and ASCO immunotherapy toxicity management guidelines are based on expert consensus and systematic review of available literature.
  1. Haanen J. et al; ESMO Guidelines Committee. Electronic address: Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Dec;33(12):1217-1238. doi: 10.1016/j.annonc.2022.10.001. Epub 2022 Oct 18. PMID: 36270461.
  2. 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 Dec 20;39(36):4073-4126. doi: 10.1200/JCO.21.01440. Epub 2021 Nov 1. Erratum in: J Clin Oncol. 2022 Jan 20;40(3):315. PMID: 34724392.