Stimulating immune responses to fight cancer: Basic biology and mechanisms

O’Byrne, Kenneth J.

doi:10.1111/ajco.12410

Cited by 11 publications

(10 citation statements)

References 52 publications

(53 reference statements)

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“…Inhibition of these physiologic checkpoints cause upregulation of cytotoxic T-cell activity and tumor death. 6,7 To date, a range of ICIs have been manufactured, including but not limited to nivolumab and pembrolizumab (PD-1 inhibitors), ipilimumab (a CTLA4 inhibitor), and durvalumab and atezolizumab (programmed death ligand 1 inhibitors).…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab-Induced Encephalopathy: A Review of Neurological Toxicities with Immune Checkpoint Inhibitors

Feng

Coward

McCaffrey

et al. 2017

Journal of Thoracic Oncology

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The use of immune checkpoint inhibitor (ICI) therapy in the treatment of solid organ malignancies is becoming increasingly common. This has prompted the recognition of a new class of immune-related adverse effects (irAEs) stemming from the upregulation of T-cell activity causing autoimmunity. Neurological irAEs are a rare complication of ICIs that can lead to long-term morbidity. We report a rare case of encephalopathy after treatment with pembrolizumab, to which the patient achieved durable disease response despite discontinuation of therapy. We also review the pathophysiology, incidence, clinical presentation, diagnosis, and management of neurotoxicity secondary to ICIs. Treatment requires early administration of high-dose corticosteroids, and cessation of ICI therapy is often necessary after grade 3 or 4 irAEs. However, early data suggest that neurological irAEs correlate with a favorable disease response. Consideration should also be given to the optimal duration of ICI therapy to minimize the risk of toxicity and optimize health care expenditure.

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Section: Discussionmentioning

confidence: 99%

Pembrolizumab-Induced Encephalopathy: A Review of Neurological Toxicities with Immune Checkpoint Inhibitors

Feng

Coward

McCaffrey

et al. 2017

Journal of Thoracic Oncology

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“…These chosen intervention functions, mode of delivery and resources are in the process of being trialled for feasibility in a pilot study in six ACCHS, prior to it being implemented in a full trial [ 58 , 66 ]. After this pilot study, end-users will be surveyed and interviewed to determine whether the intervention and study design need any modifications before preparing for a larger cluster randomised trial (renamed SISTAQUIT™—Supporting Indigenous Smokers To Assist Quitting).…”

Section: Discussionmentioning

confidence: 99%

Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

et al. 2017

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BackgroundIndigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS.MethodThe Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.’s “Behaviour Change Wheel” guide.ResultsTargets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients’ capability, opportunity and motivation.ConclusionsThe ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.

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“…Similarly, there is a growing understanding of the transition in macrophage state between M1 and M2 associated with the progression of radiation-associated late effects (118); alterations in the M1:M2 ratio are a common feature of the tumor microenvironment (187, 188) and are associated with immune tolerance (189, 190). Furthermore, chronic inflammation is now recognized as major factor in malignant disease (191). …”

Section: Discussionmentioning

confidence: 99%

Addressing the Symptoms or Fixing the Problem? Developing Countermeasures against Normal Tissue Radiation Injury

Williams¹,

Calvi²,

Chakkalakal³

et al. 2016

Radiation Research

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Stimulating immune responses to fight cancer: Basic biology and mechanisms

Cited by 11 publications

References 52 publications

Pembrolizumab-Induced Encephalopathy: A Review of Neurological Toxicities with Immune Checkpoint Inhibitors

Pembrolizumab-Induced Encephalopathy: A Review of Neurological Toxicities with Immune Checkpoint Inhibitors

Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

Addressing the Symptoms or Fixing the Problem? Developing Countermeasures against Normal Tissue Radiation Injury

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