Clinic designed to minimize autoimmune effects of immunotherapy treatment
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A new clinic at The Ohio State University — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Pelotonia Institute for Immuno-Oncology seeks to minimize the autoimmune effects of immunotherapy cancer treatment.
The OSUCCC — James Immunotherapy Management Clinic is led by Alexa Meara, MD, a rheumatologist who specializes in autoimmune diseases.
As use of immunotherapy in cancer treatment increases, clinicians must be aware of the potential for autoimmune adverse events. Most occur within 6 months after treatment initiation.
Finding a balance between activating the immune system to attack cancer and keeping it calm enough to avoid debilitating effects requires close cooperation and a strong partnership between oncologists and autoimmune specialists, Meara said.
“I can only imagine the mental gymnastics one has to do with having metastatic cancer and being on this lifesaving treatment that is working, but it’s causing this autoimmune disease,” Meara told Healio. “Whether they can’t lift a coffee cup or walk upstairs, or their liver or lungs are angry, or they have dry mouth, I can imagine the emotional coping conundrum and the psychological battle they’re going through. We considered all of this and how we can make this process easier for patients, and how we could help them feel comfortable talking about and managing these side effects.”
Meara also highlighted the inaugural immune related adverse event (irAE) consortium held earlier this year at Cleveland Clinic. The consortium — which attracted a variety of multidisciplinary clinicians, providers and patient partners — is designed to optimize multidisciplinary care for irAEs and organize multicenter trials to inform guidelines for managing these effects.
Healio spoke with Meara about the origins of the Immunotherapy Management Clinic and the need for collaboration to address autoimmune-related adverse events among individuals with cancer treated with immunotherapy.
Healio: How common are autoimmune adverse events among patients treated with immunotherapy, and what impact do these effects have?
Meara: Data from clinical trials and cohort studies shows anywhere from 50% to 75% of patients will have at least a grade 2 adverse event. The question becomes: Are all minor side effects created equal? Also, what persists and what becomes the new normal? Those questions have become much more difficult to answer. That’s why we have gotten this consortium together. We’re trying to get a better handle — from a national and international sense — of how we can classify, diagnose and treat these patients in a better way. I also think we have a nomenclature problem. Calling these “events” is a problem; it’s a new autoimmune sequelae or disease, not just one event. It’s very different from this idea of having a neutropenic fever and then not having it, or having neuropathy and then not having it. Some of it is “one and done.” For something like colitis, however, “one and done” could mean 6 months of recovery.
Healio: How did the Immunotherapy Management Clinic come about?
Meara: I was running the multidisciplinary vasculitis clinic with a nephrologist and a pulmonologist. Not all autoimmune disease is related to joint pain — some is multiorgan multisystem, and you need various other health care partners. I had developed a reputation as a “zebra doctor” — I saw the rarest of the rare cases. As immunotherapy was starting, I began to see these patients. I was already caring for complicated cases of lupus and vasculitis. Having both cancer and an autoimmune disease seemed as complex as you can get, so that’s how I became involved in caring for these patients.
It was clear that new immunotherapy indications for different cancers were increasing every day. Immunotherapy was quickly becoming the standard of care for many cancers, such as melanoma and lung cancer. I started to recognize that rheumatology was going to see more patients who had autoimmune complications of immunotherapy, and we would need a more organized approach to care for these patients. Academics can be quite siloed, and it was just easier to come together with oncology and figure out a plan to care for these patients with immune-related adverse events. I think it created a process where oncologists were able to share their perspective of what they wanted to do with these drugs, and I could help them modify to ensure their success and the patient’s success. It was very organic.
Healio: What is the scope of this project?
Meara: I see patients for 2 full days per week, along with a cancer survivorship nurse practitioner. Our clinic has worked amazingly well, and we are constantly driving to improve how we care for our patients, understand these diseases and improve survivorship for these patients. We’re looking at how to ensure that we make this experience better and enable patients to stay on treatment. We want them to feel comfortable talking about the adverse events and the management of those events.
Healio: How will this effort evolve, and could other institutions adopt a similar program?
Meara: Many academic centers have a rheumatologist like me who is very interested in this. It really depends on the politics and the dynamics of the academic medical center and how well integrated the oncology, internal medicine and rheumatology divisions are. My hope is that the advent of chimeric antigen receptor T-cell therapy for noncancer indications will force these divisions to talk and work together. I’d like to see some of these silos start to break down on the industry side and regulatory side and, therefore, on the patient side. I am an example of one model, where a rheumatologist lives in oncology. I have found it to be very beneficial, but I respect that it can’t work for everyone. My hope is that our efforts and the obstacles we are facing now will make everyone’s lives easier in terms of moving forward.
Reference:
- The Ohio State University Comprehensive Cancer Center. Rheumatologists join oncology space to treat debilitating side effects without affecting cancer control (press release). Available at: https://james.multimedia-newsroom.com/index.php/2024/04/10/rheumatologists-join-oncology-space-to-treat-debilitating-side-effects-without-affecting-cancer-control/. Posted April 10, 2024. Accessed June 8, 2024.
For more information:
Alexa Meara, MD, can be reached at alexa.meara@osumc.edu.
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