{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:28:24Z","timestamp":1788532104265,"version":"build-2803163510"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) produce durable antitumor activity by releasing inhibitory immune pathways, but the same pharmacology can disrupt peripheral tolerance and generate immune-related adverse events (irAEs) that are delayed, recurrent, chronic, multisystem, and clinically nonspecific. Organ-specific guidelines are indispensable once toxicity is suspected; however, clinical surveillance commonly begins with an undifferentiated patient report or an objective abnormality rather than a confirmed organ diagnosis. This narrative review integrates clinical pharmacology, immunobiology, guidelines, pharmacovigilance principles, patient-reported outcome research, digital monitoring studies, and multidisciplinary implementation evidence. Focused, non-systematic searches of PubMed\/MEDLINE and the Cochrane Library, supplemented by current guidelines and official regulatory sources, were finalized on 18 July 2026; representative strategies, an evidence-provenance map, and a structured comparison with existing approaches are provided in the Supplementary Material. We define an individual-level safety alert as a new symptom, functional change, laboratory abnormality, physiological change, imaging finding, or other clinically meaningful observation requiring contextual assessment. It is not equivalent to a formal population-level pharmacovigilance signal. The immune-related symptom web is a symptom-centered but not symptom-exclusive model that organizes exposure chronology, individual baseline, symptom and objective-data combinations, trajectories, competing diagnoses, corticosteroid tapering, discontinuation, rechallenge, and consequence-weighted urgency. The Signal-Attribution-Escalation-Longitudinal Management (SAELM) framework translates this information structure into an accountable workflow from alert capture to attribution, escalation, guideline-linked management, documentation, and reassessment. Its novelty lies in integrating and longitudinally organizing existing components rather than inventing each component. The Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and electronic patient-reported outcome (ePRO) systems are positioned as capture and communication tools, not diagnostic or causal instruments. The models remain conceptual and hypothesis-generating. The most feasible first validation study is a prospective multicenter observational cohort with independent clinical adjudication; the primary safety outcome should be the false-negative proportion for severe or organ-threatening irAEs, accompanied by alert burden, response time, and potentially avoidable urgent escalation.<\/jats:p>","DOI":"10.3389\/fphar.2026.1942034","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T14:05:57Z","timestamp":1788530757000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The immune-related symptom web in immune checkpoint inhibitor therapy: a longitudinal clinical safety surveillance framework for immune-related adverse events"],"prefix":"10.3389","volume":"17","author":[{"given":"Bing","family":"Li","sequence":"first","affiliation":[{"name":"Department of Oncology, The First Bethune Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haina","family":"Che","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Bethune Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfeng","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Bethune Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"121","DOI":"10.7326\/M17-2073","article-title":"Use of immune checkpoint inhibitors in the treatment of patients with cancer and preexisting autoimmune disease: a systematic review","volume":"168","author":"Abdel-Wahab","year":"2018","journal-title":"Ann. 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