Immune-related adverse events from checkpoint inhibitors: An evidence-based management review.

Immune checkpoint inhibitors (ICIs) improve cancer outcomes but can cause immune‑related adverse events (irAEs) in any organ. Corticosteroids remain first‑line, achieving remission in ∼70-85%: grade 2 toxicities typically use oral prednisone 0.5-1 mg/kg/day, while grade 3-4 require IV methylprednisolone 1-2 mg/kg/day (or pulses for life‑threatening disease). However, 20-40% of severe irAEs are steroid‑refractory and need rapid, organ‑directed escalation-mycophenolate for hepatitis/pneumonitis; infliximab or vedolizumab for colitis; IVIG and plasma exchange for neurologic syndromes; and investigational abatacept for myocarditis, which carries ∼35-50% mortality and demands aggressive multidisciplinary care. Emerging salvage options include JAK inhibitors (≈70.8% response in grade ≥3 refractory cases), extracorporeal photopheresis, and targeted cytokine blockade. Long‑term issues include chronic sequelae (≈40-50%), surveillance, and complex ICI rechallenge decisions, especially in elderly patients and those with autoimmune disease. Prospective trials, standardized monitoring, and predictive biomarkers are urgently needed. As ICIs move into curative-intent settings, optimizing irAE care preserves safety and treatment continuity.