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Consensus recommendations aim to align management of immunotherapy side effects
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The Society for Immunotherapy of Cancer released the first set of consensus recommendations on the diagnosis and management of immune checkpoint inhibitor-related adverse events.
The guidelines, published in Journal for ImmunoTherapy of Cancer, are intended to help clinicians provide timely and effective management of immune-related toxicities among their patients with cancer.
“New immunotherapy agents are being approved at a rapid pace. We are excited that patients have new treatment options. However, many of these agents have side effects that we have not seen before,” Igor Puzanov, MD, MSCI, FACP, chief of melanoma and director of the early-phase clinical trials program at Roswell Park Comprehensive Cancer Center, said in a press release.
“We are seeing effects on the skin, lungs, gastrointestinal and endocrine systems, joints, heart and other organs, and some of these are only just beginning to be described,” Puzanov added. “Clinicians need guidance on how to recognize early signs, how to treat adverse effects and when to refer to a disease specialist.”
HemOnc Today spoke with Puzanov about how the guidelines came about, why they are needed and what they encompass.
Question: How did these guidelines come about?
Answer: My colleagues and I were working on a book to help inform physicians about how immunotherapies were different from chemotherapy, and how to better manage the side effects of these therapies. We realized writing the book was going to take some time, so we decided to create these guidelines for physicians to be able to quickly check and refer to. The Society for Immunotherapy of Cancer established a multidisciplinary toxicity management working group, which met for a full-day workshop to develop recommendations to standardize management of immune checkpoint inhibitor-related adverse events.
Q: Why are the guidelines needed?
A: These new agents have a distinct set of side effects that differ from traditional chemotherapy side effects, and they differ depending upon the agent being used. Data are emerging that suggest checkpoint inhibitors may affect a number of organ systems. However, the majority of these side effects — when caught early — are mild and can be treated with drugs that temporarily suppress the immune system. We want to ensure that clinicians recognize and know how to manage these emerging side effects so patients can continue to take advantage of the unquestionable benefits of immunotherapy.
Q: Can you summarize the key recommendations?
A: Physicians should be aware that patients who are undergoing treatment for cancer, especially stage IV cancer, may be on immunotherapy. Moreover, physicians need to be aware that these agents have unique side effects with different treatments required. This is critical, and physicians must be aware of which patients are on immunotherapy. Resources are available to physicians via electronic and printed form. No one will ever remember every detail, so it is important for physicians to refer to these documents routinely. We have broken down the adverse events into two key categories regarding the frequency with which they are seen in clinical practice. These include frequently reported adverse events — such as dermatologic, gastroenterological, endocrine, respiratory and rheumatologic/musculoskeletal events — and uncommon adverse events, such as cardiovascular, hematologic, renal, neurologic and ophthalmologic events. Infusion reactions also are addressed. Within each body system, information is divided into three sections — clinical presentation and epidemiology, diagnostic evaluation and guidance on when to refer to a disease specialist. The key message for physicians is this: Know what to look for and intervene early. These unique side effects usually are effectively managed as long as they are caught and treated early. If a patient has a skin rash, for example, do not assume it is not of concern. Ask the patient about it.
Q: What do frontline physicians need to know in terms of best practices?
A: They should never be too confident. They should always check their resources. They have to recognize the side effects and grade them properly.
Q: How will these guidelines be disseminated?
A: They are available free on the website for the Journal for ImmunoTherapy of Cancer, the society’s official journal. The Society for Immunotherapy of Cancer’s leadership makes it a priority to share information like this without a paywall. This is a dynamic effort. The recommendations will evolve and be updated as new data, new agents and new combination therapies become available.
Q: Is there anything else that you would like to mention?
A: Physicians should adhere to these recommendations, because no expert will remember every side effect detail. Additional resources are in the works. ASCO and National Comprehensive Cancer Network also released guidelines. Many of the experts who were involved with the Society for Immunotherapy of Cancer’s guidelines are now part of an international team that has been assembled to create a book on this topic. We hope these resources will be useful for all practitioners, not only oncologists. I would like to acknowledge and thank all of my colleagues who worked with me on this project. – by Jennifer Southall
Reference:
Puzanov I, et al. J Immunother Cancer. 2017;doi:10.1186/s40425-017-0300-z.
For more information:
Igor Puzanov, MD, MSCI, FACP, can be reached at Roswell Park Comprehensive Cancer Center, Elm and Carlton streets, Buffalo, NY 14263; email: igor.puzanov@roswellpark.org.
Disclosure: Puzanov reports no relevant financial disclosures.