Key Points
- Gastrointestinal immune-related adverse events (irAEs) are among the most common irAEs, and although they are typically mild to moderate in severity, if they are left unrecognised or untreated, they can become life-threatening.
- All patients presenting with severe or life-threatening (Grade 3 + 4) diarrhoea or colitis should be managed using the UKONS Acute Oncology Initial Management Guidelines.
- On admission patients must be screened for Infliximab administration suitability; waiting for the results should not delay treatment.
- Consider referral and potential transfer to Gastroenterology.
- Infliximab used for this indication is funded by FHFT. Refer to the Frimley Health formulary for more information.
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Abbreviations
| BOPA | British Oncology Pharmacy Association |
|---|---|
| ICPI | Immune Checkpoint Inhibitor |
| IOCN | Immuno-Oncology Clinical Network |
| irAE | Immune-related adverse events |
| NMP | Non-Medical Prescriber |
| SACT | Systemic Anti-Cancer Therapy |
| UKONS | United Kingdom Oncology Nursing Society |
Patient presenting with severe Grade 3 + 4 diarrhoea or colitis associated with Immune Checkpoint Inhibitor (ICPI)
Possible ICPI: e.g. ipilimumab, nivolumab, pembrolizumab, avelumab, atezolizumab, durvalumab, cemiplimab.
UKONS Acute Oncology Initial Management Guidelines Version 4.0
IOCN/BOPA Infliximab in the Management of Immune-Related Adverse Effects (irAEs) Version 1.0
Infliximab dose is administered according to FHFT Infliximab infusion protocol:
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Complete pre-treatment checklist
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Prepare dose following instructions
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Administer pre-meds and use filter for Infliximab
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Document required clinical observations