ICI Dissemination Challenges Highlighted at ASCO 2026

Immune checkpoint inhibitors have fundamentally altered the treatment landscape for a growing number of cancers, including melanoma, non-small cell lung cancer, renal cell carcinoma, and various gastrointestinal malignancies.¹ Their mechanism of action, involving the restoration of anti-tumour immunity, frequently results in immune-related adverse events (irAEs) that differ in presentation and management from conventional chemotherapy toxicities.² Effective management of irAEs, ranging from dermatological and gastrointestinal to endocrine and neurological manifestations, is critical for patient safety and treatment continuation.³

However, the global oncology community continues to grapple with the uneven distribution of these life-extending therapies and the inconsistent application of evidence-based irAE management guidelines.⁴ This disparity is not merely an issue of drug availability; it extends to the infrastructure, specialist training, and diagnostic capabilities required to safely administer and monitor patients on ICIs.⁵

Dissemination and Toxicity Management Challenges

Discussions at ASCO 2026 highlighted that while the pipeline for novel ICIs and combination therapies remains robust, the focus is increasingly shifting towards implementation science.⁶ A recurring theme was the significant variability in access to ICIs, particularly between high-income and low-to-middle-income countries.⁷ This gap is exacerbated by the high cost of these agents and the complex regulatory pathways for approval and reimbursement.⁸

Beyond access, the consistent application of irAE management protocols presents a substantial hurdle.⁹ Guidelines from major oncology organisations, such as ASCO and ESMO, provide detailed recommendations for the grading and management of irAEs, often involving corticosteroids and other immunosuppressants.¹⁰ However, real-world data indicate that adherence to these guidelines varies widely. Factors contributing to this variability include a lack of awareness among non-oncology specialists, limited access to diagnostic tools (e.g., specific hormone assays for endocrinopathies), and the absence of multidisciplinary teams equipped to handle complex irAEs.¹¹

For example, immune-related endocrinopathies, such as hypophysitis or thyroid dysfunction, require prompt recognition and lifelong hormone replacement in some cases.¹² Similarly, immune-related colitis or pneumonitis can be life-threatening if not managed aggressively with high-dose corticosteroids and, in refractory cases, infliximab or vedolizumab.¹³ The ability to rapidly diagnose these conditions and initiate appropriate treatment is often contingent on the availability of specialist endocrinologists, gastroenterologists, or pulmonologists, which is not uniformly present across healthcare systems.¹⁴

The lack of standardised patient education on potential irAEs also contributes to delayed presentation and increased severity.¹⁵ Patients in settings with less robust follow-up infrastructure may not recognise early symptoms, leading to more advanced and harder-to-manage toxicities.¹⁶ The need for digital health solutions and telemedicine to bridge these gaps was frequently discussed, particularly for remote monitoring and specialist consultations.¹⁷

The patient populations most affected by these disparities often reside in rural areas or regions with underdeveloped healthcare systems. These individuals may face significant travel burdens to access specialized oncology centers, further delaying diagnosis and treatment of irAEs. The complexity of ICI administration and monitoring necessitates a well-coordinated healthcare team, including oncologists, nurses, pharmacists, and various subspecialists, to ensure optimal patient outcomes. The absence of such integrated care models in many regions represents a critical limitation in the widespread and safe dissemination of ICIs.

Furthermore, the long-term implications of untreated or inadequately managed irAEs can significantly impact patient quality of life and survival, even after successful cancer treatment. Chronic endocrine deficiencies, for instance, require ongoing management and can affect daily functioning. The economic burden associated with managing severe irAEs, including hospitalizations and specialized medications, also poses a challenge for healthcare systems, particularly in resource-limited settings. Addressing these systemic issues requires a multi-faceted approach that considers not only drug accessibility but also the entire ecosystem of care surrounding ICI therapy.

The consensus from ASCO 2026 was that while the scientific community continues to push the boundaries of ICI efficacy, a concerted global effort is required to ensure that these innovations reach all patients who could benefit, accompanied by the necessary support systems for safe and effective toxicity management.¹⁸ This includes investing in training programs for healthcare professionals, developing more affordable treatment options, and establishing robust data collection systems to monitor real-world outcomes and identify areas for improvement.¹⁹