# Baseline tests and monitoring before and during checkpoint inhibitor treatment

Source: https://onco.cc/protocols/checkpoint-inhibitor-baseline-and-monitoring/  
OnCo record `checkpoint-inhibitor-baseline-and-monitoring` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Before immunotherapy such as pembrolizumab or nivolumab starts, your team checks your blood count, kidney and liver tests, thyroid and often cortisol and sugar levels, and asks about autoimmune and lung conditions. Some tests are repeated before each dose, because immunotherapy side effects are often found on a blood test before you feel them.

## Summary

SITC 2021: before starting, full blood count with differential, a comprehensive metabolic panel, TSH and free T4; consider urinalysis for baseline kidney disease; consider an ECG for people at higher risk of myocarditis (cardiac disease, diabetes, combined anti-PD-(L)1 and anti-CTLA-4), and baseline troponin may be considered. Liver tests before every infusion; blood count, metabolic panel, TSH and free T4 intermittently throughout, with thyroid tests every 4 to 6 weeks on treatment and every 6 to 12 months after it ends. Education on irAEs, contraception and fertility; a careful risk-benefit discussion for people with autoimmune disease (LE: 1) and specialist referral with lung function tests for autoimmune interstitial lung disease (LE: 3).

ESE 2022 sets a baseline minimum for everyone of morning (08:00 to 09:00) TSH, free T4, cortisol, glucose and electrolytes (sodium, potassium, calcium), repeated every 4 to 6 weeks, preferably before each cycle, and adds ACTH, LH, FSH, oestradiol or testosterone, prolactin and HbA1c where hypophysitis risk is higher, such as with ipilimumab. ESMO 2022 and the ESC 2022 cardio-oncology guideline could not be read.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: baseline tests before immunotherapy; ICI pre-treatment screening; checkpoint inhibitor monitoring bloods; thyroid and cortisol monitoring on immunotherapy; pre-immunotherapy checklist
- Tags: protocol; irae

## Connected records

- protocols: [Checkpoint inhibitor hypophysitis and adrenal insufficiency: emergency treatment, replacement and steroid emergency card](https://onco.cc/protocols/irae-hypophysitis-adrenal/), [Immune-mediated hepatitis from checkpoint inhibitors, by grade](https://onco.cc/protocols/irae-hepatitis/), [Immune-related diarrhoea and colitis from checkpoint inhibitors, by grade](https://onco.cc/protocols/irae-colitis/), [Immune-related myocarditis from checkpoint inhibitors](https://onco.cc/protocols/irae-myocarditis/), [Immune-related pneumonitis from checkpoint inhibitors, by grade](https://onco.cc/protocols/irae-pneumonitis/), [Immune-related skin reactions from checkpoint inhibitors, including blistering and severe erosive rashes](https://onco.cc/protocols/irae-skin/), [Immune-related type 1 diabetes and diabetic ketoacidosis from checkpoint inhibitors](https://onco.cc/protocols/irae-diabetes/), [Kidney inflammation (immune-related nephritis) from checkpoint inhibitors](https://onco.cc/protocols/irae-nephritis/), [Thyroid inflammation and underactive thyroid from checkpoint inhibitors](https://onco.cc/protocols/irae-thyroid/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Troponin and natriuretic peptide monitoring during cancer treatment](https://onco.cc/technologies/cardiac-biomarker-monitoring/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Avelumab](https://onco.cc/drugs/avelumab/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Dostarlimab](https://onco.cc/drugs/dostarlimab/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Society for Immunotherapy of Cancer](https://onco.cc/institutions/sitc/)
- terms: [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Immune-related endocrinopathies (thyroiditis, hypophysitis)](https://onco.cc/terms/immune-endocrinopathy/), [Immune-related myocarditis](https://onco.cc/terms/myocarditis/)

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