{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:17:11Z","timestamp":1777936631601,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Oncol"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pulmonary toxicities caused by immune checkpoint inhibitors are a prominent concern for clinicians. Clinical Practice Guidelines (CPGs) are critical for managing these toxicities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic search of CPGs on checkpoint-associated pulmonary toxicities (ca-PT) was conducted in October 2022. PubMed, Embase, Cochrane Library, CINAHL, and Web of Science were searched. AGREE II and AGREE-REX were used to appraise CPGs and recommendations quality, respectively. Descriptive statistics, intraclass correlation coefficient, Kruskal-Wallis (H) test, and Spearman\u2019s correlation were used for analyses. P-values\u2009&lt;\u2009.05 were considered statistically significant. Matrices were used to determine recommendation differences between CPGs. The study\u2019s design was based on the PRISMA 2020 checklist for systematic reviews. Protocol registration number: CRD42022358435.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eight CPGs (two high-quality, three moderate-quality, and three low-quality) were identified. All CPGs covered pneumonitis. One CPG covered pleural effusions and pneumonitis\/SARs-CoV-2-infection. Three CPGs covered sarcoidosis-like-reactions. CPGs for pulmonary fibrosis, airway disease, bronchiolitis, and diffuse alveolar damage, were unavailable. No CPG recommendation was based on a prospective study, and none were appraised as high-quality. Also, recommendations were not specific to histopathologic subtypes. AGREE II\u2019s \u201crigor of development,\u201d the domain that evaluates a guideline\u2019s methodological approach and strategies in gathering scientific evidence, correlated strongly with AGREE-REX\u2019s \u201coverall quality\u201d pneumonitis recommendations, r\u2009=\u2009.952; P\u2009&lt;\u2009.01. Approximately 73% of recommendations on pneumonitis were similar between high-quality CPGs. About 16% to 74% of low-quality CPGs were similar to those recommended by high-quality CPGs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Prospectively designed research projects focusing on all types of ca-PT and their histopathologic subtypes are urgently needed. Due to the lack of high-quality recommendations in available CPGs, the disparities in treatment recommendations between high-quality CPGs, and the similarities in recommendations that exists between high-quality and low-quality CPGs, clinicians should thoroughly assess and responsibly appraise all available CPG recommendations in formulating treatment strategies for ca-PT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795549231203153","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T03:56:23Z","timestamp":1699502183000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["A Systematic Review of Clinical Practice Guidelines for Managing Pulmonary Toxicities Caused by Immune Checkpoint Inhibitors: Quality of Treatment Recommendations and Differences in Management Strategies Between Guidelines"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1360-0887","authenticated-orcid":false,"given":"Kofi N","family":"Donkor","sequence":"first","affiliation":[{"name":"Department of Hematology\/Oncology, Loma Linda University Health, Loma Linda, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeree","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Loma Linda University Health, Loma Linda, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reena","family":"Sail","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Scripps MD Anderson Cancer Center, San Diego, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"bibr1-11795549231203153","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.743582"},{"key":"bibr2-11795549231203153","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01785"},{"key":"bibr3-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-79308-1_14"},{"key":"bibr4-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.2453"},{"key":"bibr5-11795549231203153","volume":"363","author":"Xu C","year":"2018","journal-title":"BMJ"},{"key":"bibr6-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-pathol-042020-042741"},{"key":"bibr7-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2021-002896"},{"key":"bibr8-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1053\/j.semnuclmed.2018.11.001"},{"key":"bibr9-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090449"},{"key":"bibr10-11795549231203153","unstructured":"AGREE-REX-Research-Team. AGREE-REX: recommendation excellence. 2019. https:\/\/www.agreetrust.org\/wp-content\/uploads\/2019\/04\/AGREE-REX-2019.pdf. Accessed April 20, 2022."},{"key":"bibr11-11795549231203153","volume":"372","author":"Page MJ","year":"2021","journal-title":"BMJ"},{"key":"bibr12-11795549231203153","unstructured":"Donkor K, Jang H, Sail R. A systematic review of clinical practice guidelines [CPGs] on the management of checkpoint-associated pulmonary toxicity: AGREE II\/AGREE-REX CPG quality appraisals and differences in treatment recommendations [PROTOCOL]. https:\/\/osf.io\/2rdju\/. Published August 22, 2022. 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Immune checkpoint inhibitor toxicity management clinical practice guideline (Version 1). https:\/\/www.cancercareontario.ca\/sites\/ccocancercare\/files\/guidelines\/full\/ImmuneCheckpointInhibitor.pdf. Published March 2018. Accessed October 22, 2022."},{"key":"bibr18-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.10.001"},{"key":"bibr19-11795549231203153","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05708-2"},{"key":"bibr20-11795549231203153","unstructured":"Management of immunotherapy-related toxicities. Version 1.2022. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/immunotherapy.pdf. 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