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VIDEO: Toxicities related to immune therapies ‘unpredictable’ but ‘manageable’
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James P. Allison, PhD, chair of the department of immunology and executive director of the immunotherapy platform at MD Anderson Cancer Center in Houston, discusses toxicities related to immune-based strategies to treat cancer.
“The initial hope of immunotherapy was that it would be really, really specific and there would be no collateral damage to normal tissues,” he said. “We’ve learned from experience with anti-CTLA–4 and anti-PD–1 that there are significant adverse events that can be lethal.”
Describing the mechanistic responses as more of a “cytokine storm” or “runaway inflammation” than actual autoimmunity, Allison cites colitis, pneumonitis and the less-frequent hepatitis among the side effects.
He tells how algorithms developed using systemic steroids effectively prevent recurrence of events, noting this allays initial fears about interference with the immune agents. Although the lack of predictability with immunotherapy continues to pose concerns, Allison emphasizes the toxicities are manageable.
“It’s the uncertainty that troubles people. These are really variable,” he said. “Education and close communication with patients is the best solution.”