Authored by members of the ACCC IO Institute Working Groups, the Immuno-Oncology Insights series brings forward perspectives and real-world strategies for tackling current challenges in delivery of immunotherapy for cancer, as well as thought-provoking, potential next steps for optimizing care in this rapidly growing field. Reader response is encouraged.
Envision a day that cancer clinicians can ask an app to advise on immuno-oncology (IO) treatment options for a patient. That day may not be far off. Big data, deep analytics, and predictive modeling methods are transforming how cancer clinicians weigh treatment options.
Immune-related adverse events (irAEs) are extremely common in patients being treated with checkpoint inhibitors for advanced melanoma. The type, quality, and severity of these adverse events, however, varies by treatment regimen and by patient.
As a genitourinary medical oncologist specializing in immunotherapy for kidney and bladder cancers, I am continually striving for more ways to connect with and learn from my patients. The emerging availability of immuno-oncology (IO) drugs for the conditions I treat, as well as many other cancer types, has generated tremendous excitement amongst patients and oncologists, but there still is so much we don’t know.
The positive impacts of IO therapy are remarkable, the era of IO has also ushered in new challenges. The efficacy of IO has led to a growing population of patients living with and beyond cancer. This has challenged original concepts of survivorship care, starting with the very definition of “survivorship.”
Our busy community practice first began treating patients with immunotherapy through participating in the original ipilimumab clinical trials. We quickly realized that this new treatment paradigm would require us to create and implement an effective screening and management tool for our immunooncology (IO) patient population.
Patients with complex medical needs, such as those with active autoimmune conditions, hepatitis B or C, and those receiving corticosteroids at baseline, may now receive these agents in the community. This raises important questions regarding safety, monitoring, and the likelihood of an anticancer response in these patients.
Immune-related adverse events (irAEs) are a complex category of
symptoms driven by anti-cancer immunotherapy treatments.
The use of IO has burgeoned since the approval of ipilimumab
in 2011 through multiple approvals of anti-PD-1/PD-L1 drugs
and most recently CAR-T therapies, and so too has the number of
Survivorship care planning requires communication, care coordination, and education. Since immune-related adverse events are still being discovered, these discussions are even more imperative.
Oncodermatology is a rapidly developing field that is attracting significant interest and generating new literature in the context of cancer treatment strategies.
The non-specific adverse events of immune-based therapies, which often mimic autoimmune disorders rather than traditional cytotoxic effects, pose a significant challenge to emergency medicine providers.
Caring for patients experiencing toxicities from treatment with immune checkpoint inhibitors (ICIs) requires multidisciplinary input and coordination. Rheumatologists evaluate and treat patients experiencing a wide variety of immune-related adverse events (irAEs), including inflammatory arthritis, sicca syndrome, polymyalgia rheumatica, myositis, vasculitis, and scleroderma. It’s important for rheumatologists to know that these irAEs can vary significantly in their time of onset, severity, and treatment. Accurately diagnosing and treating rheumatic irAEs requires that providers obtain a tailored patient history and physical examination, since there are no definitive diagnostic laboratory tests for these complications.
While immuno-oncology (IO) therapies have heralded significant advancements in cancer care, there are still many unknowns when it comes to the long-term side effects of these relatively new agents. Since ambulatory care typically involves long-term chronic disease management, these unknowns can often translate to management uncertainty.
When diagnosed with cancer, the typical patient responds
with trepidation, anxiety, and fear. This experience
engenders a bewildering set of questions, including the
cause, treatment options, prognosis, appropriate sources of care,
and affordability. Of paramount importance is ready access to expert
resources with the requisite knowledge and skill. Telemedicine is a
modality of care that addresses all these issues.
In the current oncology clinical trials landscape, many barriers
remain to clinical trial enrollment that affect both the oncologist
and the patient. Among these are trial locations, strict eligibility
requirements, insufficient resources to support appropriate clinical
trial education and screening, as well as patient and provider
attitudes about trials.
Emergency physicians are partners in providing care to your acutely ill patients. Since emergency physicians’ experience with and exposure to the novel immunotherapies is relatively limited, it is important that ED physicians and nurses are aware of the indications for these agents and informed on potential acute and chronic complications of immunotherapy for cancer.
SARS-CoV-2 and the resulting respiratory tract infection COVID-19 has upended our society and forcefully changed the way we care for patients. Since the emergence of the virus in early 2020, there have been questions surrounding the risk posed to patients with a cancer diagnosis and the safety of anticancer therapies.
Immuno-oncology (IO) has radically altered the patient care paradigm. One of most important changes attributed to IO is improvement in outcomes and lengthening of survival. This good news comes with multiple challenges, not least of which is the need for new and better communication and coordination among multiple specialties over time.
Are you leveraging the assets of your oncology pharmacists in delivery of immunotherapy for cancer? Oncology pharmacists multidisciplinary team members who help bridge the gap between science and real-world medical practice. Sarah Hudson-DiSalle, PharmD, RPh, describes how your IO program can make the best use of the oncology pharmacist's diverse skillset.
The human gastrointestinal tract is inhabited by a diverse
population of bacteria that play a crucial role in maintaining
homeostasis both within the gut and within the body. How much do we know about the gut microbiome as it relates to cancer treatment?
As with other high-cost treatments, integration of immunotherapies
into practice requires a thorough understanding
of payer policies and requirements for reimbursement. Sarah Hudson-DiSalle, PharmD, RPh, shares key steps for successful reimbursement for cancer immunotherapies.
A forthright conversation between the treating clinician, patient and family members on the importance of self-reporting adverse events must take place prior to consideration of combination immunotherapy.
Research nurse Joannne Riemer, RN, BSN, started her position at Johns Hopkins Medical Institution in 2010. Within six months, she was working with checkpoint inhibitors. From her vantage point in clinical trials research, she discusses the many changes in IO clinical trials patient selection over the last eight years.