Review Article

Supportive Care and Management of Treatment-Related Adverse Effects From Immune Checkpoint Inhibitors and Targeted Therapies in Melanoma

Krista M. Rubin, MS, FNP-BC, and Lisa A. Kottschade, APRN, MSN, CNP

Massachusetts General Hospital Cancer Center, Center for Melanoma, Boston, Massachusetts; and Department of Medical Oncology, Mayo Clinic, College of Medicine, Rochester, Minnesota

Authors’ disclosures of conflicts of interest are found at the end of this article.

Krista M. Rubin, MS, FNP-BC, 32 Fruit Street, YAW 7E, Boston, MA 02114. E-mail: kmrubin@mgh.harvard.edu

ABSTRACT

Abstract

Molecularly targeted agents, and notably, the immune checkpoint inhibitors, are now considered standard therapies for the treatment of advanced melanoma and have forever changed the treatment paradigm for this difficult-to-treat disease. The adverse event profile associated with each class stems from the respective mechanism of action and varies considerably from traditional chemotherapy. By possessing a thorough understanding of the side effects of each agent, oncology advanced practitioners are in pivotal positions to positively influence treatment outcomes. Awareness, vigilant screening, early identification and prompt intervention, as well as providing comprehensive patient and caregiver education are key strategies of toxicity management and enable patients the greatest chance of treatment continuation. This article provides an overview of the spectrum of toxicities associated with immune checkpoint inhibitors. It focuses on the most commonly encountered toxicities and will describe the less common but clinically challenging toxicities. The molecularly targeted agents, including BRAF and MEK inhibitors, will also be reviewed, along with an overview of management strategies for common toxicities. Patient and caregiver resources are included as a reference.

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