Original Research| Volume 130, P39-50, May 2020

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The 2016–2019 ImmunoTOX assessment board report of collaborative management of immune-related adverse events, an observational clinical study

Published:March 12, 2020DOI:


      • Severe irAEs (grade III-IV) occurred earlier than mild irAEs (grade I-II) in this study.
      • The main medical needs in the management of immune-related adverse events (irAEs) involved the lung organ.
      • Rechallenge after previous irAE was assessed as feasible in 65% of cases.
      • Initiation of immunotherapy in patients with autoimmune comorbidity was assessed as feasible in 93% of cases.
      • A multidisciplinary approach could help to better appraise and manage irAEs in real life.



      We investigated the activities of an ImmunoTOX board, an academic, multidisciplinary group of oncologists and organ specialists that adopts a real-life, case-by-case approach in the management of patients with immune-related adverse events (irAEs).

      Experimental design

      The ImmunoTOX assessment board was set up in 2016 at Gustave Roussy in France. It meets every 2 weeks to discuss the case-by-case management of patients presenting with irAEs. Here, we describe the ImmunoTOX board's activities between 2016 and 2019.


      Over study period, 398 requests (concerning 356 patients) were submitted to the ImmunoTOX board. Most of the requests concerned the putative causal link between immunotherapy and the irAE (n = 148, 37%), followed by possible retreatment after temporary withdrawal because of an adverse event (n = 109, 27%), the clinical management of complex situations (n = 100, 25%) and the initiation of immunotherapy in patients with pre-existing comorbidities (n = 41, 10%). The ImmunoTOX board discerned 273 irAEs. The five organ systems most frequently involved by irAEs were lung (n = 58, 21%), gastrointestinal tract (n = 36, 13%), liver or biliary tract (n = 33, 12%), musculoskeletal system (n = 27, 10%), and nervous system (n = 23, 8%). The time to occurrence was shorter for severe irAEs (grade III and VI) than for mild irAEs (grades I and II), with medians of 47 and 91 days, respectively (p = 0.0216).


      The main medical needs in the management of irAEs involved the lung organ. Severe irAEs were expected to occur earlier than mild irAEs. This real-life study can help to better estimate medical needs and therefore help to assess the management of irAEs.


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