Abstract
Immune-related adverse events (IRAEs) are becoming increasingly common as the use of immune checkpoint inhibitors expands into more tumor types and treatment settings. Although the majority of IRAEs are mild and can be managed in the outpatient setting by the medical oncologist, severe IRAEs can be life threatening and often require complex care coordination among multiple providers. These providers include a variety of non-oncology specialists who have interest and expertise in managing IRAEs. Multiple systems-based solutions have been proposed in the literature, but these need to be tailored to the needs and resources of each practice setting. In this article, we highlight the challenges of IRAE care by presenting an illustrative case from our institution. We then describe the format and structure of the IRAE Tumor Board established at the University of Washington/Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center. Finally, we discuss how this tumor board attempts to address clinical issues related to complex IRAE presentations and provide IRAE education.
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No funding was received for the preparation of this article. Training support for Laura C. Kennedy, Nikhil V. Kamat, and Ali Raza Khaki was provided by the National Cancer Institute (T32 CA009515).
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Laura C. Kennedy, Kit Man Wong, Nikhil V. Kamat, Ali Raza Khaki, and John A. Thompson have no conflicts of interest that are directly relevant to the content of this article. Shailender Bhatia reports advisory board participation (with honorarium) from Genentech, EMD-Serono, Bristol-Myers-Squibb (BMS), and Sanofi Genzyme and research funding to his institution (University of Washington) from Oncosec, EMD-Serono, Merck, BMS, NantKwest, Immune Design, Novartis, Nektar, and Exicure. Petros Grivas has conducted unrelated consulting with AstraZeneca, Bayer, Biocept, Bristol-Myers Squibb, Clovis Oncology, Driver, EMD Serono, Exelixis, Foundation Medicine, Genentech, Genzyme, GlaxoSmithKline, Heron Therapeutics, Janssen, Merck, Mirati Therapeutics, Pfizer, Seattle Genetics, QED Therapeutics, and Roche; and has received institutional research funding from AstraZeneca, Bayer, Genentech/Roche, Merck, Mirati Therapeutics, Oncogenex, Pfizer, Clovis Oncology, Bavarian Nordic, Immunomedics, Debiopharm, Bristol-Myers Squibb, Kure It Cancer Research, and QED Therapeutics (in the last 36 months).
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Kennedy, L.C., Wong, K.M., Kamat, N.V. et al. Untangling the Multidisciplinary Care Web: Streamlining Care Through an Immune-Related Adverse Events (IRAE) Tumor Board. Targ Oncol 15, 541–548 (2020). https://doi.org/10.1007/s11523-020-00739-5
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DOI: https://doi.org/10.1007/s11523-020-00739-5