Immuno-Oncology Toxicity Initiative
As the use of immunotherapy continues to expand across cancer care, immune-related adverse events have become an increasingly important clinical challenge. While these therapies can produce durable responses in patients with cancer, they also can trigger inflammatory and autoimmune toxicities that affect virtually any organ system.
The Immuno-Oncology Toxicity (IOTOX) Initiative at UT MD Anderson brings together specialists from Internal Medicine, Cancer Medicine and multiple other disciplines to address the growing challenges of immunotherapy-related toxicities. By integrating patient care, scientific discovery and professional education, the initiative works to reduce the burden of immune-related adverse events and improve outcomes for patients receiving cancer immunotherapy.
IOTOX Core Focus Areas
Clinical Care
The IOTOX Initiative provides multidisciplinary expertise for the evaluation and management of immune-related adverse events associated with immunotherapy.
Clinical priorities include:
- Developing evidence-based recommendations for immune-related toxicities
- Promoting coordinated, multidisciplinary care across specialties
- Supporting comprehensive evaluation and management of toxicities affecting multiple organ systems
- Advancing standardized approaches to diagnosis and treatment Improving patient outcomes through early recognition and intervention
Rising Volume of ICI-Treated Patients at UT MD Anderson Cancer Center
From 2010 to 2025, UT MD Anderson saw a total of 27, 874 patients receiving immune checkpoint inhibitor treatment.
- 2010: 44
- 2011: 148
- 2012: 169
- 2013: 320
- 2014: 574
- 2015: 1,272
- 2016: 1,893
- 2017: 2,849
- 2018: 3,763
- 2019: 4,310
- 2020: 3,957
- 2021: 4,109
- 2022: 4,595
- 2023: 5,047
- 2024: 5,261
- 2025: 5,295
Between 2020 and 2025, the patietn population grew at a compound annual growth rate of 6%. Overall, the number of ICI-treated patients increased more than one hundredfold between 2010 and 2025, with the highest annual volume occurring in 2025.
Clinical Management Algorithms
UT MD Anderson clinicians have developed evidence-based clinical management algorithms to support the evaluation and treatment of common immune-related toxicities:
- IOTOX: Dermatologic Toxicities - Evaluation and Management
- IOTOX: Endocrine Toxicities - Evaluation and Management
- IOTOX: Pneumonitis - Evaluation and Management
- IOTOX: Suspected Colitis - Evaluation and Management
- IOTOX: Suspected Nephritis - Evaluation and Management
- IOTOX: Pancreatitis and Pancreatic Injury - Evaluation and Management
Mobile Clinical Decision Support
The IOTOX clinical algorithm app provides convenient access to management recommendations and clinical guidance for healthcare professionals caring for patients receiving immunotherapy.
Research
The initiative supports clinical and translational research aimed at advancing understanding of immune-related adverse events and improving patient outcomes.
Research efforts include:
- Accelerating translational and clinical research
- Building infrastructure to support collaborative investigation
- Advancing biologically informed studies of immunotherapy-related toxicities
- Collecting biospecimens to improve understanding of toxicity mechanisms and treatment response
- Fostering multidisciplinary collaboration across clinical and research programs
Foundational Publication
The development and strategic framework of the IOTOX Initiative is described in our study, “Development of a Strategic Initiative at MD Anderson Cancer Center to Improve Outcomes in Immune-Related Adverse Events,” published in Journal of National Comprehensive Cancer Network.
Education
Education is a cornerstone of the IOTOX Initiative. We provide resources and learning opportunities designed to support healthcare professionals caring for patients receiving immunotherapy.
Educational activities include:
- Clinical guidance and best-practice recommendations
- Expert lectures and case-based discussions
- Multidisciplinary educational programs
- Continuing professional education opportunities
- Patient education resources and support tools
IOTOX Educational Lecture Series
The IOTOX Educational Lecture Series brings together experts from multiple specialties to discuss emerging research, practical management strategies and challenging immune-related adverse event cases.
The series is held monthly and is open to health care professionals interested in immunotherapy toxicity management. For Morbidity and Mortality (M&M) Sessions, RME credit is also available. However, each participant may claim only one type of credit (CME or RME) per session.
Upcoming sessions
- Nov. 10, 2026 - Morbidity & Mortality Session 1
8-9 am | Zoom link
Nupur Kikani, MD Assistant Professor Endocrine Neoplasia & HD, UT MD Anderson
- Jan. 12, 2027 - Dermatology Toxicity
8-9 am | Zoom link
Fiorinda Muhaj, M.D., Assistant Professor, Dermatology, UT MD Anderson
Noah Hornick, M.D., Ph.D., Assistant Professor, Dermatology, Oregon Health & Science University
To request information about upcoming sessions, please contact IOTOXLeads@mdanderson.org.
Symposia and Educational Events
The IOTOX Initiative hosts and participates in educational symposia focused on advancing the understanding and management of immune-related adverse events.
Past and upcoming programs include
Event information, future programming and registration details will be posted as available.
Professional Resources
The IOTOX Initiative develops practical resources to assist clinicians caring for patients receiving immunotherapy.
Resources may include:
- Clinical management algorithms
- Diagnostic ICD-10 coding references
- FDA-approved immunotherapy drug references
- IOTOX handbooks, such as “Challenging Cases in Immunotherapy Related Organ Toxicities,” by Yinghong Wang, M.D., Ph.D., and educational publications
- eBooks and professional learning materials
- Patient education tools and symptom management resources
Patient Resources
Patients receiving immune checkpoint inhibitors may be provided with tools that promote communication and early recognition of potential toxicities, including an immunotherapy wallet card that documents treatment information, provider contact information and common immune-related symptoms that may require evaluation.