Immunotherapy 'tidal wave' demands interdisciplinary approach
SCOTTSDALE, Ariz. — In the face of the “tidal wave of cancer immunotherapy,” collaboration across disciplines is required to manage immune-related adverse events associated with checkpoint inhibitors, according to a presentation at the Seventh Annual Basic and Clinical Immunology for the Busy Clinician symposium.
“In 2018, there were over 900 new cancer immunotherapies in development, with over 5,000 clinical trials investigating these agents and more than half a million patients being treated with these agents,” Leonard H. Calabrese, DO, vice chairman of rheumatic and immunologic disease at the Cleveland Clinic, told attendees. “Immunotherapy is now a pillar of cancer treatment — it is now ensconced as a part of this therapy.”
With the increase in the use of checkpoint inhibitors, more patients will develop immune-related adverse events (irAEs), many of which can mirror rheumatic diseases, Calabrese noted. As irAEs can affect any organ system and vary in severity from mild to life-threatening, rheumatologists must be able to communicate with oncologists as soon as possible to improve patient outcomes.
“The treatment of [irAEs] is interprofessional — we want to see these patients early and we want to manage them with the oncologist,” Calabrese said. “We have triage systems vital for optimal care. Oncologists can’t just say ‘go see a rheumatologist’ while patients wait months for an appointment — patients need to see them now.”
According to Calabrese, major centers need to develop interprofessional groups with interested and invested consultants who can share their experience in all relevant areas. For example, the Cleveland Clinic has developed a tumor board dedicated specifically to immune-related adverse events, in which clinicians of various divisions and specialties meet once per month to present cases, review the latest literature and trade notes.
“If we know more about the immunopathogenesis, we as rheumatologists will be able to proffer more rationally targeted therapies,” Calabrese said. “I think that rheumatologists have a special place and we think we have a lot to offer to this evolving field.” – by Robert Stott
Calabrese LH. Autoimmune Manifestations of Cancer Immunotherapy. Presented at: Seventh Annual Basic and Clinical Immunology for the Busy Clinician; February 15-16, 2019; Scottsdale, Ariz.
Disclosure: Calabrese reports he is a consultant for Abbvie, Bristol-Myers Squibb, Genentech, GlaxoSmithKline, Jansen, Pfizer and Sanofi; and is on the speakers bureau for Abbvie, Bristol-Myers Squibb, Crescendo Bioscience and Genentech.