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Supportive care for patients undergoing immunotherapy

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Abstract

Immune checkpoint inhibitors, a new class of cancer therapeutic agents, play an important role in the management of melanoma, NSCLC, and other malignancies. A workshop organized by three MASCC Study Groups: Oral Care, Skin Toxicities, and Neutropenia, Infection, and Myelosuppression during the MASCC Annual Meeting held in Adelaide, Australia on 23–25 June, 2016 focused on the new class of anti-cancer therapeutic agents. Topics in the workshop included the mechanism of action and clinical uses of immune anti-CTL4 and anti-PD1 antibodies, checkpoint inhibitor toxicities, including skin adverse events, gastrointestinal toxicities, oral complications, pulmonary toxicities, and endocrinological and immune-related infections. Checkpoint inhibitors have been approved for use in different malignancies including metastatic melanoma, advanced non-small cell lung cancer, metastatic renal cell carcinoma, refractory Hodgkin’s lymphoma, metastatic bladder cancer, and advanced head and neck cancer, and the list continues to grow. In general, these agents seem to be better tolerated in most patients and less toxic compared to conventional chemotherapy. However, the toxicities here, termed immune-related adverse events (irAEs), are unique and different from what we have seen in the past. There is no prospective data on these toxicities, and guidelines or recommendations are currently based on symptomatic management from the ongoing clinical trials. Treating oncologists need to be aware and alert themselves to the subtleties in presentation and the big difference in the way we manage the irAEs. Although most irAEs are low-grade and manageable, they have the potential to be life-threatening and extremely severe if not promptly treated. Additionally, irAEs could even lead to death, if managed incorrectly. The MASCC workshop addressed the various irAEs, per organ system, clinical presentation, management recommendations, and individual toxicities.

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Authors and Affiliations

  1. The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold 2196, Johannesburg, South Africa

    Bernardo Leon Rapoport & Ronwyn van Eeden

  2. Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

    Bernardo Leon Rapoport

  3. Department of Medical Oncology and Clinical Research Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, France

    Vincent Sibaud

  4. Department of Oncodermatology, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, France

    Vincent Sibaud

  5. Cedars-Sinai Health System, Samuel Oshin Comprehensive Cancer Institute, Los Angeles, CA, USA

    Joel B. Epstein

  6. Institut Jules Bordet, Université Libre de Bruxelles, Centre des Tumeurs de l’ULB, Rue Héger Bordet, 1, 1000, Brussels, Belgium

    Jean Klastersky

  7. Institut Multidisciplinaire d’Oncologie, Clinique de Genolier, Genolier, Switzerland

    Matti Aapro

  8. University of the Witwatersrand and Wits Donald Gordon Medical Center, Johannesburg, South Africa

    Devan Moodley

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  1. Bernardo Leon Rapoport
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  2. Ronwyn van Eeden
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  3. Vincent Sibaud
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  4. Joel B. Epstein
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  5. Jean Klastersky
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  6. Matti Aapro
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  7. Devan Moodley
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Corresponding author

Correspondence to Bernardo Leon Rapoport.

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Conflict of interest

Bernardo Leon Rapoport: Has speaking, consultant, advisory board roles, and contract research with Merck and Co. and BMS South Africa. Also, has funded research grant from BMS South Africa.

Ronwyn van Eeden: None.

Vincent Sibaud: Has a speaking, consultant, or advisory role with Roche, GlaxoSmithKline, Pierre Fabre, Merck, Bristol-Myers Squibb, Bayer, and Boehringer Ingelheim.

Joel B. Epstein: Has funded research supported by Dr. Falk Pharma, Amgen Inc., OraHealth Inc., and Synedgen Inc. and has advisory roles for Dara Biosciences, Galera Pharmaceuticals, Medactive Biopharmaceuticals, Onxeo Inc., and Vigilant Biosciences.

Jean Klastersky: Has a speaking, consultant, or advisory role with TEVA and Amgen.

Matti Aapro: Has speaking, consultant, and advisory board roles with BMS, Amgen, Pfizer, and MSD.

Devan Moodley: None.

Additional information

Proceedings of a workshop co-sponsored by MASCC Oral Care Study Group, MASCC Skin Toxicities Study Group, and MASCC Neutropenia, Infection, and Myelosuppression Study Group during the MASCC Annual Meeting held in Adelaide, Australia 27–29 June, 2016.

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Rapoport, B.L., van Eeden, R., Sibaud, V. et al. Supportive care for patients undergoing immunotherapy. Support Care Cancer 25, 3017–3030 (2017). https://doi.org/10.1007/s00520-017-3802-9

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