Expert consensus on nursing management of immune-related adverse events in patients with advanced non-small cell lung cancer

doi:10.3877/cma.j.issn.1674-0785.2026.02.001

Abstract

Abstract:

Immune therapy has significantly improved the prognosis of patients with advanced non-small cell lung cancer. However, the associated immune-related adverse events directly affect the patients' survival benefits and quality of life. The occurrence of immune-related adverse events shows individual variability and is closely related to factors such as treatment cycles. Therefore, there is an urgent clinical need to implement individualized treatment and nursing interventions based on the specific types and severity of immune-related adverse events. Based on the latest domestic and international evidence-based medical evidence, this consensus systematically integrated relevant guidelines and literature, and elaborated in detail on the incidence rates, risk factors, hierarchical management strategies, and targeted nursing measures for various immune-related adverse events in the immunotherapy of advanced non-small cell lung cancer, as well as key points for guidance on home care, aiming to provide standardized and systematic scientific guidance for clinical nursing practice, enhance patients' self-management ability, and ensure treatment safety and continuity.

Key words: Lung cancer, Immunotherapy, Adverse events, Expert consensus

Xiumei Chen, Manying Xie, Sijuan Chen, Xuhui Zhong, Qiao Pan, Lijuan Wen, Expert Consensus Writing Group. Expert consensus on nursing management of immune-related adverse events in patients with advanced non-small cell lung cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2026, 20(02): 77-89.

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References 71

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分级	描述
1级	轻度：无症状或轻微；仅为临床或诊断所见，无需治疗。
2级	中度：需要较小、局部或非侵入性治疗；与年龄相当的工具性日常生活活动受限。
3级	严重或者具重要医学意义但不会立即危及生命；导致住院或者延长住院时间；致残；自理性日常生活活动受限。
4级	危及生命；需要紧急治疗。
5级	与irAEs相关的死亡。

分级	描述
1级	轻度：无症状或轻微；仅为临床或诊断所见，无需治疗。
2级	中度：需要较小、局部或非侵入性治疗；与年龄相当的工具性日常生活活动受限。
3级	严重或者具重要医学意义但不会立即危及生命；导致住院或者延长住院时间；致残；自理性日常生活活动受限。
4级	危及生命；需要紧急治疗。
5级	与irAEs相关的死亡。

分级	定义	处理
1级	覆盖＜10%体表面积，伴或不伴症状，轻度或局部瘙痒。	做好清洁、保湿和防晒。
2级	覆盖10%~30%体表面积，伴或不伴症状，广泛分布且间歇发作瘙痒。	推荐采用局部治疗。外用局部激素软膏（如氢化可的松）可减轻炎症反应，缓解皮疹和瘙痒症状。同时联合口服抗组胺药可进一步控制瘙痒症状。
3级	覆盖＞30%体表面积，伴有中重度症状，广泛分布且持续发作瘙痒；影响活动或睡眠。	需暂停免疫治疗，防止病情进展。除局部治疗外，给予口服类固醇（0.5~1 mg/kg/d泼尼松当量）在4周内逐渐减量，通过抑制免疫系统的过度反应减轻皮肤的炎症症状。
4级	危及生命；需要紧急治疗。

分级	定义	处理
1级	覆盖＜10%体表面积，伴或不伴症状，轻度或局部瘙痒。	做好清洁、保湿和防晒。
2级	覆盖10%~30%体表面积，伴或不伴症状，广泛分布且间歇发作瘙痒。	推荐采用局部治疗。外用局部激素软膏（如氢化可的松）可减轻炎症反应，缓解皮疹和瘙痒症状。同时联合口服抗组胺药可进一步控制瘙痒症状。
3级	覆盖＞30%体表面积，伴有中重度症状，广泛分布且持续发作瘙痒；影响活动或睡眠。	需暂停免疫治疗，防止病情进展。除局部治疗外，给予口服类固醇（0.5~1 mg/kg/d泼尼松当量）在4周内逐渐减量，通过抑制免疫系统的过度反应减轻皮肤的炎症症状。
4级	危及生命；需要紧急治疗。

分级	定义	处理
1级	转氨酶ALT/AST＜3倍ULN	继续免疫治疗，加强肝功能监测
2级	转氨酶ALT/AST 3~5倍ULN	暂停免疫治疗，并给予口服泼尼松［剂量：1~2 mg/（kg·d）］，以减轻肝脏的炎症反应，至1级时逐渐减量
3级	转氨酶ALT/AST 5~20倍ULN
4级	转氨酶ALT/AST＞20倍ULN

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