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Eight years ago, the Cancer Research Institute designated June as Cancer Immunotherapy Month, an annual effort to increase awareness of cancer immunotherapy clinical trials and the need for more funding for immunotherapy (IO) research.
During the past decade, IO research has made tremendous strides in bringing new, life-saving treatments to patients with cancer. The FDA has approved immunotherapies to treat more than 20 types of cancer, as well as cancers with specific genetic mutations. There are now IO options for front-line therapy, in which immunotherapies are the first course of treatment rather than potentially toxic chemotherapy or radiation treatments. Immunotherapies have also been shown to work synergistically with other treatments, giving patients additional options.
In recognition of Cancer Immunotherapy Month, ACCCBuzz talked to Sigrun Hallmeyer, MD, the chair of the ACCC Immuno-Oncology Institute’s Executive Committee. Dr. Hallmeyer is the director of the Cancer Institute and medical director of the Cancer Survivorship Program at Advocate Lutheran General Hospital in Park Ridge, Ill.
Dr. Hallmeyer is also the co-director of the PRC Russell Institute for Research and Innovation. She specializes in the treatment of breast cancer and melanoma and has an avid interest in immuno-oncology. Dr. Hallmeyer has served on American Society of Clinical Oncology expert panels for the management of immunotherapy-related toxicities and for sexual dysfunction in cancer survivors.
ACCCBuzz: What is the most promising IO research today?
Dr. Hallmeyer: We are expanding the efficacy of what we’ve already accomplished in the treatment of diseases that have historically responded to IO. Specifically, treatments for kidney cancer and melanoma are constantly evolving, and we are optimizing the drugs already approved by the FDA in terms of scheduling changes.
For example, many of these drugs are now given every four weeks or every six weeks, when it used to be every two weeks or every three weeks, significantly increasing patient convenience. We are also becoming much better at identifying the side effects of IO treatment early, so patients are able to continue therapy because their toxicities are managed early and aggressively before they become so severe that patients need to stop treatment. And then there are so many new treatment combinations, of old agents with new agents, and brand-new agents with new agents—new combination therapies that are being employed to treat diseases that historically have not responded to IO.
ACCCBuzz: What is the role of IO in survivorship?
Dr. Hallmeyer: It’s huge. IO and survivorship have become practically synonymous. IO is delivering on the promise of helping cancer patients living longer. Some of these patients may not necessarily be cured, but they can now live with their malignancies.
Where people have historically been preparing for their deaths, now they're preparing for a prolonged survival, living with their disease while in continual treatment. With IO, getting treatment for long periods has become bearable. That is because there are very few cumulative toxicities that occur with IO treatment—unlike getting chemotherapy, where many patients have to stop treatment not because their cancer didn't respond, but because they could not live with the cumulative toxicities the chemo causes.
None of that applies to immunotherapy. When a patient responds to IO, they can be exposed to these treatments for months and even years, so survivorship has completely changed for many patients with metastatic disease. Ultimately, patients will die from their illness, but how they die—and, more important, how they live—has completely changed with the advent of immunotherapies.
ACCCBuzz: Has there been progress in educating healthcare professionals about how to respond to IO adverse events?
Dr. Hallmeyer: I think that's probably where we've made the biggest improvement. There is so much education and so many publications in terms of the importance of early intervention and early recognition of immune-related side effects. That has really impacted patients’ candidacy for continued immunotherapy, and it is ultimately the key to being successful with IO. Many different professional societies have come up with guidelines, and I think physicians really take advantage of them. And not just physicians, but nurse practitioners and nurses too—the whole care team.
This has made a huge impact on our ability to manage immunotherapy patients and educate them about when to call the oncologist and when to come to the emergency room. If they do go to the ER, they know to tell doctors that they are not on chemotherapy; they are immunotherapy recipients and may have an immune-related side effect. I think the learning curve across the board has been significant, not just for providers, but also for patients in understanding the potential toxicities that they may experience and the importance of treating them effectively the first time. Teaching that has really made a big difference.
ACCCBuzz: What is the overall status of physician adoption of IO therapies?
Dr. Hallmeyer: When we started all this back in 2011, when physicians spoke to other doctors about IO and how to respond to side effects, the common response was, “Oh, I will never deal with that. This is like bone marrow transplantation; if I see a patient who qualifies for this treatment, I’ll just refer them to someone with more expertise. This is not something I'm going to get into.” That was the theme when IO was introduced a decade ago. If you still have that kind of response today, you will refer yourself out of business. IO has become the mainstay of therapy for much of what we do in both immunology and medical oncology, so today’s physicians must gain that experience. Even if you haven’t necessarily absorbed that type of knowledge in a conference or haven’t read the research, you’ve been exposed to it so much now, you are expected to have learned it on your own.
I think the huge learning curve that IO presented has significantly flattened out just by virtue of the explosive availability of IO therapies in the community, and the sheer necessity for physicians to learn to work with this particular class of drug. In many cases, it has become the standard of care, and if you want to practice oncology today, you have to understand it.
Since its founding in 2015, the ACCC Immuno-Oncology Institute has worked to guide multidisciplinary cancer care teams in their adoption of IO in community cancer centers. Through clinical education, advocacy, research, and practice management solutions, the IO Institute seeks to bring new therapies to the treatment of traditionally recalcitrant cancers.
Recent IO Institute publications include Survivorship Care Plans for Patients Receiving Immunotherapy, a resource for cancer programs and practices that describes processes for developing survivorship care plans (SCPs), effective practices in SCP design, and considerations for SCP delivery in community cancer centers.
Immuno-Oncology in 2020: What We’ve Learned and What Lies Ahead addresses how to meet the needs of the evolving multidisciplinary cancer care team and the needs of other interdisciplinary providers involved in caring for patients treated with IO. Other IO Institute resources include education programs, podcasts, white papers, journal articles, blog posts, and other tools.