The Society for Immunotherapy of Cancer's handbook,SITC’s Guide to Managing Immunotherapy Toxicity, is a practical reference to managing side effects associated with FDA-approved cancer immunotherapy drugs. Separated into two parts, Part I contains chapter-based overviews of immune checkpoint inhibitors in the clinic, starting with anti-CTLA4 agents, anti-PD1/PD-L1 agents, and approved immunotherapeutic combinations. These chapters cover relevant mechanisms of action, indications, and toxicities seen while combating early, advanced, and metastatic stages in cancer patients. Part II is structured by common and uncommon toxicities that affect major organ sites throughout the body. It begins with a general summary of principles and management options followed by chapters focusing on specific toxicities such as rash and mucosal irritation, muscle and joint toxicity, diarrhea and colitis, pneumonitis, endocrine toxicities, neurological toxicities, cardiac toxicity, renal toxicity, hematologic toxicity, and ocular toxicities. Each chapter provides guidance on how to assess and treat the toxicity and how to support the patient through acute and chronic effects with detailed summary tables for quick reference. Part II concludes with chapters covering management of special patient populations, including patients with autoimmune disease and geriatric patients, treatment and management of fatigue, and a final chapter dedicated to cost effectiveness and the toll of financial toxicity on patients and caregivers. With chapters written by world-recognized leaders in the immuno-oncology field, this text provides thorough coverage of the toxicity and management of adverse effects for immune checkpoint inhibitors. It is an indispensable resource for clinical oncologists, emergency physicians, hospitalists and other medical practitioners in both the hospital and community clinic settings, especially as the use of immune checkpoint inhibitors becomes a fixture in oncology care. Key Features: Outlines strategies for treating high-risk patients facing an acute or chronic side effect to immunotherapy Provides numerous tables that condense and highlight pertinent information for quick reference Describes the various clinical presentations and toxic reactions caused by immunotherapy Purchase includes access to the eBook for use on most mobile devices or computer

For the faultless function of the immune system, tight regulation of immune cell activation, immuno-suppression and the strength and efficiency of the immune response is essential. Immune checkpoint (ICP) molecules can amplify or dampen signals that lead to the modulation of specific immune activities. Under physiological conditions, immune checkpoints are essential to prevent autoimmune manifestations and to preserve self-tolerance. They help modulate immune responses by either promoting or inhibiting T-cell activation. However, in the context of cancer, malignant cells can dysregulate the expression of immune checkpoint proteins on immune cells in order to suppress anti-tumor immune responses and to gain immune resistance. Moreover, tumor cells themselves can also express some checkpoints proteins, thereby enabling these cells to externally orchestrate immune regulatory mechanisms. Several recent studies have confirmed that the expression of immune checkpoints could be an important prognostic parameter for cancer development and for patient outcome. Therefore, cancer immunotherapy based on the modulation of immune checkpoint molecules alone, or in combination with conventional tumor therapy (chemo- or/and radiotherapy), is now in focus as a means of developing new therapeutic strategies for different types of cancer. The two well-known molecules - CTLA4 and PD-1 - serve as important examples of such checkpoint proteins of important therapeutic potential. Thus far, inhibitors of CTLA4 and PD-1 have been approved to treat only a limited number of malignancies (e.g. malignant Melanoma, Non-Small Cell Lung Cancer). Many others are currently under investigation and the list of immune checkpoint molecules for potential therapeutic targeting is still growing. However, the clinical response to inhibitors of checkpoint molecules is not sufficient in all cases. Therefore, further studies are needed to improve our knowledge of such immunomodulatory proteins and their associated signaling pathways. Several key signaling pathways which are involved in the regulation of expression of checkpoint molecules in immune cells and in cancer cells have already been identified including MAPK, PI3K, NF-kB, JAKs and STATs. These (and future discovered) signaling pathways could give rise to the development of new strategies for modulating the expression of ICPs and thereby, improving anti-cancer immune responses. The main aim of the Research Topic is to collect novel findings from scientists involved in basic research on immune checkpoints as well as in translational studies investigating the use of checkpoint inhibtors in immunotherapy in experimental settings. We welcome the submission of Review, Mini-Review and Original Research articles that cover the following topics: 1. Molecular mechanisms underlying regulation of ICP expression in immune and/or cancer cells. 2. Characterization of signaling pathways downstream ICP molecules. 3. Cellular responses to ICP blockade. 4. Identification of new compounds interfering with ICP expression and/or signaling. 5. ICP-mediated interactions between cancer cells and immune cells. 6. Functional links between ICP and cytokines/chemokines. 7. Molecular mechanisms of ICP inhibition in the context of experimental cancer immunotherapy.

Background: Immune checkpoint inhibitors have revolutionized advanced non-small cell lung cancer treatment. Some patients may now come with impressive responses persisting over the years. To this day, the optimal duration of ICI treatment remains unknown, as well as the determinants for its eventual discontinuation. Methods: We conducted a retrospective multicentric study analyzing the characteristics of patients who discontinued ICI after 2 years of treatment in the setting of controlled disease. Results: Thirty-eight patients stopped ICI after 2 years of treatment between March 2015 and December 2020, and were analyzed. The median treatment duration was 26,5 months (range 21-47), and the median follow-up duration was 54 months (range 25-92). The median PFS from ICI discontinuation was reached at 23.5 months and the median OS from ICI discontinuation was reached at 24.5 months. At one year, OS and PFS rates were of 97.37% (95% CI 92.41 - 100) and 89% (95% CI 79.36 - 99.8), respectively. At the 24-month mark after discontinuation, these rates were of 85.53% (95% CI 73.03 - 100) for OS and 66.88% (95% CI 51.66 - 86.59) for PFS. In a univariate cox model analysis, we demonstrated that having a CT response (CR or PR) at discontinuation enabled better OS (HR = 8.8 (95%CI 1.8 - 44.1), pvalue= 0,001) and having a CMR at the PET/CT évaluation allowed a better PFS (HR = 7.1 (95%CI 1.1- 15.5), pvalue= 0.005). Conclusion: The findings suggest that for a select group of patients with controlled cancer at the two-year mark, discontinuing immunotherapy may be a feasible option, as it does not necessarily lead to an immediate resurgence of the disease. Further research and clinical trials are needed to establish evidence-based guidelines.