Abstract
Since so few patients respond to IO therapy, a key priority is to determine who is most like to have a positive response to these potentially life-saving drugs. Now, a simple listserv is helping to improve the care of Johns Hopkins cancer patients who can benefit from these drugs. Physicians within the Johns Hopkins Health System can receive rapid advice from a multidisciplinary team of colleagues who have experience treating immune-related adverse events (AEs) that often follow the use of immune checkpoint inhibitors. Referral requests are emailed to the team and answers are provided within 24 hours.
“Immune-related adverse events can affect every part of the body and can sometimes be challenging to diagnose since onset and duration of symptoms vary greatly,” said Laura Capelli, a rheumatologist and assistant professor of medicine. “Having a team of specialists at the ready allows us to provide more rapid and effective care for patients and to balance their oncologic and rheumatologic needs.”
Up to 43.6% of U.S. patients with cancer are eligible to be treated with immune checkpoint inhibitors (ipilimumab, pembrolizumab, nivolumab, avelumab, atezolizumab, durvalumab, cemiplimab), including those with melanoma and renal cell carcinoma. It is likely that hundreds of thousands of U.S. patients receive them each year. They act by blocking the negative regulation of T cells, which supercharges T cell activity against cancer cells—but also increase inflammation, harming tissues and organs throughout the body and causing immune-related AEs.
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According to Cappelli, the number of patients who experience these side effects is hard to pin down because many AEs go unrecognized as such. One estimate is that 15% to 50% of patients receiving immune checkpoint inhibitors develop an immune-related AE. “The range is wide in part because drug regimens differ,” she said. “Combination therapies, for example, are known to trigger more AEs.”
AEs most commonly involve the skin, liver, gastrointestinal tract and endocrine glands, but the full list is quite long, including pneumonitis, vitiligo, type 1 diabetes, neuropathy, inflammatory arthritis and myositis. The broad spectrum of affected tissues makes multidisciplinary collaboration a must.