Emergency management of immune-related toxicity

Expert Review of Clinical Pharmacology

Johnson

et al. 2021

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Introduction: Patients with hematological and advanced solid malignancies have acquired immune dysfunction, often exacerbated by treatment, posing a significant risk for development of infections. These are often difficult to diagnose and poorly responsive to anti-infective therapy. This review evaluates the utility of current clinical and treatment guidelines, as well as recent and emerging innovative approaches and therapies, in the setting of management of infections in cancer patients.Areas Covered: These include causes of infection in cancer patients, management of patients with high-risk and low-risk febrile neutropenia, management of low-risk patients in an outpatient setting, the role of granulocyte colony-stimulating factor (G-CSF) in the prevention and treatment of neutropenia-related infections, management of lung infections in various clinical settings, and emerging challenges surrounding the risk of infection in cancer patients treated with novel treatments, including targeted therapies, and immunotherapies. The literature search was performed by accessing PubMed and other databases, focusing on published clinical trials of relevant anti-cancer agents and diseases. These primarily coveried the recent past, but also included several key studies published during the last decade and, somewhat earlier in a few cases.Expert Review: Notwithstanding the promise of gene therapy/gene editing in hematological malignancies and some types of solid cancers, innovations introduced in clinical practice include more discerning clinical management such as the generalized use of biosimilar formulations G-CSF and the implementation of novel, innovative immunotherapies.

Section: Infections Associated With Targeted Therapiesmentioning

confidence: 99%

Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)

Rapoport

Expert Review of Clinical Pharmacology

Johnson

et al. 2021

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“…In addition, treatment with ICIs is associated with an increased number of activated T cells and a reduction in the numbers and immune suppressive activities of cells of the antiinflammatory Treg phenotype, leading to T-cell dysregulation and development of IrAEs [27]. IrAEs include fatigue, skin, gastrointestinal, liver, pulmonary, endocrine, ocular, neurological, and rarely type 1 diabetes, cardiac, pancreatitis, as well as those of hematological origin [26,28]. Ophthalmological IrAEs in the form of episcleritis, uveitis, or conjunctivitis have also been reported [29].…”

Section: Supportive Care Of Patients Undergoing Treatment With Immune...mentioning

confidence: 99%

Supportive care for new cancer therapies

Rapoport

Current Opinion in Oncology

Johnson

et al. 2021

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Purpose of reviewThe past decade has witnessed unprecedented delivery to the clinical arena of a range of novel, innovative, and effective targeted anticancer therapies. These include immunotherapies, most prominently immune checkpoint inhibitors, as well as agents that target growth factors and cancer-related mutations. Many of these new cancer therapies are, however, associated with an array of toxicities, necessitating insight and vigilance on the part of attending physicians to achieve high-quality supportive care alongside toxicity management. In this review, we consider some of the key supportive care issues in toxicity management. Recent findingsAlthough both supportive care and targeted therapies have brought significant benefits to cancer care, the management of novel cancer therapy toxicities is nevertheless often complex. This is due in large part to the fact that target organs differ widely, particularly in the case of checkpoint inhibitors, with minor dermatological disorders being most common, while others, such as pneumonitis, are more severe and potentially life threatening. Accordingly, efficient management of these immune-related adverse events requires collaboration between multiple medical specialists.

“…Cancer patients receiving immune checkpoint inhibitors require education, early and prompt recognition of emerging IrAEs and prompt management to mitigate any potential long-term consequences. [28,29] Advanced Practice Providers (APPs), specialist nurses and patient navigators trained in the care of irAEs are perfectly positioned to optimize patients' quality of care for the growing number receiving immunotherapy. In this setting, APPs provide patient education, are trained in assessing symptoms of immune-related toxicities, collaborate with consultative services, and develop management strategies.…”

Section: Role Of Advanced Practice Provider and Patient-provider Comm...mentioning

confidence: 99%

“…The American Society of Clinical Oncology has issued guidelines on effective communication with a goal to optimize the patient-clinician relationship, as well as patient, clinician and family well-being [30]. Key communication skills include exploring the patient's understanding of their disease, engaging in behaviors that foster trust and collaboration and providing information that is timely and oriented to the patient's preferences and values [29].…”

Section: Patient Provider Communicationmentioning

confidence: 99%

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune checkpoint inhibitor endocrinopathies and the role of advanced practice providers in the management of immune-mediated toxicities

Girotra

Ginex

et al. 2020

Support Care Cancer

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Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment, transforming outcomes in melanoma and showing benefit in a range of malignancies. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Immune-mediated endocrinopathies include hypophysitis, thyroiditis, and insulin-dependent diabetes mellitus. These presentations, which may be vague and non-specific, can be life-threatening if not diagnosed and treated appropriately. This review considers the work-up and management of immune-mediated endocrinopathies and also considers the role of advanced practice practitioners in the management of immune-mediated toxicities.These state-of-the-art MASCC recommendations represent a comprehensive overview of the management and clinical work-up in those in whom the diagnosis should be considered.