Immune Treatments in Cancer Need Additional Vigilance and Earlier Recognition

Immunotherapy, with its important clinical benefits, is not deficient of toxicities—cytokine therapies that induce capillary leakage to vaccines associated with low levels of autoimmunity to cell therapies that can induce damaging cross-reactivity with normal tissue to checkpoint protein inhibitors that induce immune-related adverse events that are autoinflammatory in nature. According to experts, a majority of these responses are T-cell—mediated adverse events that are directed against the normal, healthy tissue.

Oncologists, patients, and caregivers should all be well aware of these immune-related adverse events (irAEs). The new breed of checkpoint inhibitors, namely PD-1, PD-L1, and CTLA-4 inhibitors, are responsible for some unique irAEs, which include dermatologic, gastrointestinal, hepatic, endocrine, and other less common inflammatory events.

An abstract presented at the 16th World Conference on Lung Cancer presented results from a study that monitored irAEs resulting from treatment with immune checkpoint inhibitors. “Patients and healthcare providers must be educated about potential immune-mediated AEs prior to treatment with checkpoint inhibitors,” said Marianne Davies, NP, of the Yale Cancer Center in New Haven, Connecticut during her presentation. “Early recognition of immune-mediated AEs is essential to effective treatment,” she said.

Recommending that all patients should be monitored for existing autoimmune diseases, she explained that patients should also be assessed for baseline pulmonary function and any ongoing AEs. She emphasized the importance of patient awareness, saying that patients should be asked to notify their care provider if they develop symptoms. One unique aspect of irAEs is that they can develop within days or even months after a new dose.

Davies and her team have developed a standard algorithm to help guide members of the multidisciplinary team who care for cancer patients with assessment, monitoring, and management of irAEs with checkpoint inhibitors. The objective: early identification and treatment of irAEs can minimize the risk for advanced toxicities and long term complications.