Multidisciplinary Approach for Addressing Immunotherapy-Related Toxicities
New research published in JNCCN—Journal of the National Comprehensive Cancer Network and presented by Jarushka Naidoo, MBBCh, at the NCCN 2019 Annual Conference suggests that institutions and networks that utilize immunotherapy should consider establishing multidisciplinary teams for providing central, coordinated service for diagnosis and management of immunotherapy-related adverse events. Researchers compiled a team of subspecialists across a variety of disciplines who agreed to be contacted through a password-protected e-mail system. Team members replied to questions within 24 hours to provide the necessary feedback and referrals for the treatment of various immunotherapy-related adverse events.
Study Findings
“This service helped us identify the relevant specialists that providers can contact when needed, and may also potentially help coordinate the sharing of immunotherapy-related adverse events data for research purposes,” said lead researcher Dr. Naidoo, of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “We identified which toxicities are most likely to require subspecialty input based on the breakdown of referrals for suspected and subsequently confirmed immunotherapy-related adverse events. We found that the most commonly needed medical specialists were in pulmonary medicine, gastroenterology, endocrinology, and dermatology.”
The researchers were surprised by just how successful the program was. During the 8-month pilot period, there were 117 referrals regarding 102 different patients, with all providers receiving toxicity management recommendations within 24 hours. The team comprised eight medical oncologists; four oncology nurses; four specialists in rheumatology; three in pulmonology; two each in neurology, endocrinology, dermatology, and ophthalmology; and one each in cardiology, hematology, and infectious disease. The time commitment was approximately 4 to 6 hours per week for central members and 2 to 4 hours per week for the other specialists.
The service was so effective that referrals continued well beyond the pilot period. All 57 providers who responded to a postpilot survey reported using all or some of the recommendations they received. Nearly 74% of referring providers said they changed their diagnostic evaluation or management of an immune-related toxicity as a result of the recommendations from the team.
‘Important New Resource’
“Immune checkpoint inhibitors have revolutionized medical oncology; [immuno]therapy induces objective responses and brings improved survival to patients with a variety of cancers. However, immune checkpoint inhibitor therapy may trigger autoimmune side effects that bring inflammation and damage to virtually any tissue or organ,” commented John A. Thompson, MD, of Seattle Cancer Care Alliance and Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Management of Immunotherapy-Related Toxicity, who was not involved in the JNCCN study. “Health-care providers in all specialties are now encountering patients with these toxicities for the first time and are looking for expert, actionable advice in real time. The Multidisciplinary Immune Checkpoint Inhibitor Toxicity Consult Service described in this paper is an important new resource to support education and best-practice care, and to study these treatment-related concerns.”
The researchers found that the establishment of the multidisciplinary toxicity team was feasible and effective for addressing the urgency and unexpected timing for immunotherapy-related adverse events. However, they stressed that in the most urgent cases, patients should continue to be treated by emergency departments.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
