Clinical Recommendations for Perioperative Immunotherapy-induced Adverse Events in Patients with Non-small Cell Lung Cancer

Jun NI, Miao HUANG, Li ZHANG, Nan WU, Chunxue BAI, Liang’an CHEN, Jun LIANG, Qian LIU, Jie WANG, Yilong WU, Fengchun ZHANG, Shuyang ZHANG, Chun CHEN, Jun CHEN, Wentao FANG, Shugeng GAO, Jian HU, Tao JIANG, Shanqing LI, Hecheng LI, Yongde LIAO, Yang LIU, Deruo LIU, Hongxu LIU, Jianyang LIU, Lunxu LIU, Mengzhao WANG, Changli WANG, Fan YANG, Yue YANG, Lanjun ZHANG, Xiuyi ZHI, Wenzhao ZHONG, Yuzhou GUAN, Xiaoxiao GUO, Chunxia HE, Shaolei LI, Yue LI, Naixin LIANG, Fangliang LU, Chao LV, Wei LV, Xiaoyan SI, Fengwei TAN, Hanping WANG, Jiangshan WANG, Shi YAN, Huaxia YANG, Huijuan ZHU, Junling ZHUANG, Minglei ZHUO

Abstract


Background and objective Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). Methods This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. Results This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. Conclusion Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.


DOI: 10.3779/j.issn.1009-3419.2021.101.06

Keywords


Lung neoplasms; Perioperative immunotherapy; Immune checkpoint inhibitor related adverse events; Clinical recommendation

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