Immuno-Oncology Insights Series

Envision a day that cancer clinicians can ask an app to advise on immuno-oncology (IO) treatment options for a patient. That day may not be far off. Big data, deep analytics, and predictive modeling methods are transforming how cancer clinicians weigh treatment options.

Immune-related adverse events (irAEs) are extremely common in patients being treated with checkpoint inhibitors for advanced melanoma. The type, quality, and severity of these adverse events, however, varies by treatment regimen and by patient.

As a genitourinary medical oncologist specializing in immunotherapy for kidney and bladder cancers, I am continually striving for more ways to connect with and learn from my patients. The emerging availability of immuno-oncology (IO) drugs for the conditions I treat, as well as many other cancer types, has generated tremendous excitement amongst patients and oncologists, but there still is so much we don’t know.

The positive impacts of IO therapy are remarkable, the era of IO has also ushered in new challenges. The efficacy of IO has led to a growing population of patients living with and beyond cancer. This has challenged original concepts of survivorship care, starting with the very definition of “survivorship.”

Our busy community practice first began treating patients with immunotherapy through participating in the original ipilimumab clinical trials. We quickly realized that this new treatment paradigm would require us to create and implement an effective screening and management tool for our immunooncology (IO) patient population. 

Patients with complex medical needs, such as those with active autoimmune conditions, hepatitis B or C, and those receiving corticosteroids at baseline, may now receive these agents in the community. This raises important questions regarding safety, monitoring, and the likelihood of an anticancer response in these patients. 

Immune-related adverse events (irAEs) are a complex category of symptoms driven by anti-cancer immunotherapy treatments. The use of IO has burgeoned since the approval of ipilimumab in 2011 through multiple approvals of anti-PD-1/PD-L1 drugs and most recently CAR-T therapies, and so too has the number of recognized irAEs.

Survivorship care planning requires communication, care coordination, and education. Since immune-related adverse events are still being discovered, these discussions are even more imperative. 

When diagnosed with cancer, the typical patient responds with trepidation, anxiety, and fear. This experience engenders a bewildering set of questions, including the cause, treatment options, prognosis, appropriate sources of care, and affordability. Of paramount importance is ready access to expert resources with the requisite knowledge and skill. Telemedicine is a modality of care that addresses all these issues.

In the current oncology clinical trials landscape, many barriers remain to clinical trial enrollment that affect both the oncologist and the patient. Among these are trial locations, strict eligibility requirements, insufficient resources to support appropriate clinical trial education and screening, as well as patient and provider attitudes about trials.

SARS-CoV-2 and the resulting respiratory tract infection COVID-19 has upended our society and forcefully changed the way we care for patients. Since the emergence of the virus in early 2020, there have been questions surrounding the risk posed to patients with a cancer diagnosis and the safety of anticancer therapies. 

Immuno-oncology (IO) has radically altered the patient care paradigm. One of most important changes attributed to IO is improvement in outcomes and lengthening of survival. This good news comes with multiple challenges, not least of which is the need for new and better communication and coordination among multiple specialties over time. 

Are you leveraging the assets of your oncology pharmacists in delivery of immunotherapy for cancer? Oncology pharmacists multidisciplinary team members who help bridge the gap between science and real-world medical practice. Sarah Hudson-DiSalle, PharmD, RPh, describes how your IO program can make the best use of the oncology pharmacist's diverse skillset.  

The human gastrointestinal tract is inhabited by a diverse population of bacteria that play a crucial role in maintaining homeostasis both within the gut and within the body. How much do we know about the gut microbiome as it relates to cancer treatment?  

As with other high-cost treatments, integration of immunotherapies into practice requires a thorough understanding of payer policies and requirements for reimbursement. Sarah Hudson-DiSalle, PharmD, RPh, shares key steps for successful reimbursement for cancer immunotherapies.

A forthright conversation between the treating clinician, patient and family members on the importance of self-reporting adverse events must take place prior to consideration of combination immunotherapy.  

Research nurse Joannne Riemer, RN, BSN,  started her position at Johns Hopkins Medical Institution in 2010. Within six months, she was working with checkpoint inhibitors. From her vantage point in clinical trials research, she discusses the many changes in IO clinical trials patient selection over the last eight years.