BI11 UK consensus guidelines for the management of immune checkpoint inhibitor-induced cutaneous toxicity

Abstract

The last 15 years have seen a revolution in cancer management with the emergence of immunotherapy. Five-year survival rates for patients with advanced melanoma have risen from 10% in the preimmunotherapy era to 52% with combination ipilimumab and nivolumab therapy. Increases in overall survival have been replicated across many tumour types and usage in clinical practice continues to expand. Immunotherapy can produce toxicities in any organ, but cutaneous toxicities are the most common and the earliest to occur. Experts in immunotherapy toxicity from around the UK recognized significant limitations in published guidance at a dermatology network meeting organized by the charity Melanoma Focus. Variance in UK regional guidance was also subsequently identified. A multidisciplinary guideline development group (GDG) of dermatologists, oncologists, clinical nurse specialists and patient representatives was established to develop a consensus guideline with the support of Melanoma Focus. The GDG’s stated aim was to produce a guideline underpinned by the latest evidence and capable of meeting the needs of both patients and clinicians in the NHS. A rigorous, 2-year development process led to a draft guideline, which was revised following a national consultation run in December 2025. We will present the guideline, which consists of a ‘toolkit’ comprising two key sister documents: the acute management algorithm and a detailed specific toxicity table. These are supported by two quick-reference documents on the practical prescribing of topical therapies and principles of corticosteroid usage. Also provided is a patient information leaflet, intended for all patients due to commence immunotherapy. These guidelines will facilitate timely intervention to avoid or minimize the need for treatment breaks. They will ensure that patients across the UK, regardless of tumour type, derive the greatest efficacy from their immunotherapy, while minimizing the impact of the cutaneous toxicities on their quality of life.