Cancer Immunotherapy: An Interprofessional Approach to the Management of Immune-Mediated Adverse Events

Statement of Need

The immune system plays a vital role in surveillance, control, and eradication of cancer.1,2 However, there are numerous mechanisms by which cancer subverts normal immune function and antitumor immunity.2-4 Cancer immunotherapy may boost or restore the ability of the immune system to detect and destroy cancer cells (i.e., restore efficient immunosurveillance and cancer elimination process) by overcoming the mechanisms by which tumors evade and suppress the immune response.2 Given its recent successes in a number of tumor types, cancer immunotherapy is rapidly becoming a mainstream oncology practice. Cancer immunotherapy is associated with unique immune-mediated adverse events (imAEs) that are important to recognize early.5,6 Clinicians involved in the treatment of patients receiving immunotherapy must be knowledgeable and aware of possible imAEs and must be proactive in identifying potential imAEs.

Clinicians must be aware of warning signs and symptoms so that patients are triaged appropriately and assessed in a timely manner.5,6 Most imAEs are low grade, but all can occur rapidly, and therefore prompt medical attention is critical. There are key strategies which members of the interprofessional healthcare team can employ for successful management.

These include:

• Early detection and continued screening

• Use of treatment algorithms for imAEs

• Ongoing education of nurses, support staff, family members, and caregivers

• Referral to specialists when warranted (eg, endocrinologists, pulmonologists, etc.)

References
1Postow MA, et al. J Clin Oncol. 2015. 2Disis ML. Semin Oncol. 2014. 3Schreiber RD, et al. Science. 2011. 4Dunn GP, et al. Annu Rev Immunol. 2004. 5Weber JS, et al. J Clin Oncol. 2015. 6Fecher LA, et al. Oncologist. 2013.

Agenda

5 mins Welcome and Introductions
50 mins Presentation
5 mins Conversation with the Expert/Q&A

Target Audience

Emergency medicine and oncology clinicians (physicians, nurses, pharmacists) and other members of the interprofessional healthcare team.

Learning Objectives

At the conclusion of this application-based activity, participants will be able to:
  • Outline the key principles of the human immune response and the mechanism by which immunotherapies target various solid tumor types.
  • Examine emerging research on the clinical efficacy and safety of immune checkpoint inhibitors and identify their place in the treatment algorithm of solid tumors.
  • Identify signs and symptoms of immune-mediated adverse events associated with checkpoint inhibitor therapy and understand how to differentiate these from other etiologies, such as infection, etc.
  • Explore strategies members of the interprofessional healthcare team can employ to effectively recognize and manage imAEs in the emergency department and outpatient setting.