A Multidisciplinary Toxicity Team for Cancer Immunotherapy–Related Adverse Events

Abstract

Background: Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events (irAEs). Methods to obtain real-time multidisciplinary input for irAEs that require subspecialist care are unknown. This study aimed to determine whether a virtual multidisciplinary immune-related toxicity (IR-tox) team of oncology and medicine subspecialists would be feasible to implement, be used by oncology providers, and identify patients for whom multidisciplinary input is sought. Patients and Methods: Patients treated with ICIs and referred to the IR-tox team in August 2017 through March 2018 were identified. Feasibility was defined as receipt of electronic referrals and provision of recommendations within 24 hours of referral. Use was defined as the proportion of referring providers who used the team’s recommendations, which was determined through a postpilot survey. Demographics and tumor, treatment, and referral data were collected. Patient features and irAE associations were analyzed. Results: The IR-tox team was found to be feasible and used: 117 referrals from 102 patients were received in 8 months, all providers received recommendations within 24 hours, 100% of surveyed providers used the recommendations, and 74% changed patient management based on IR-tox team recommendations. Referrals were for suspected irAEs (n=106; 91%) and suitability to treat with ICIs (n=11; 10%). In referred patients, median age was 64 years, 54% were men, 13% had prior autoimmunity, and 46% received ICI combinations versus monotherapy (54%). The most commonly referred toxicities were pneumonitis (23%), arthritis (16%), and dermatitis (15%); 15% of patients had multisystem toxicities. Multiple referrals were more common in those treated with combination ICIs (odds ratio [OR], 6.0; P=.035) or with multisystem toxicities (OR, 8.1; P=.005). The IR-tox team provided a new multidisciplinary forum to assist providers in diagnosing and managing complex irAEs. This model identifies educational and service needs, and patients with irAEs for whom multidisciplinary care is most sought. Conclusions: A virtual multidisciplinary toxicity team for irAEs was a feasible and used service, and facilitated toxicity identification and management.

Steroid-refractory PD-(L)1 pneumonitis: incidence, clinical features, treatment, and outcomes

“…The diagnosis of ICI-pneumonitis was made by the treating medical oncologist and confirmed by a multidisciplinary team comprised of a pulmonologist, radiologist, second medical oncologist, and pathologist. 22 ICI-pneumonitis was defined as clinical and radiographic lung inflammation either during or after anti-PD-(L)1 therapy. Patients with confirmed alternative diagnoses, such as cancer progression, radiation pneumonitis, 23 or lung infection, were excluded with appropriate laboratory testing, diagnostic imaging and pathological evaluation.…”

Characteristics and Risk Factors of Cytokine Release Syndrome in Chimeric Antigen Receptor T Cell Treatment

“…CRS is one of the major complications during CAR-T cell treatment. However, current guidelines or options of management of CRS are based on data of CD19 CAR and risk assessment of CRS occurrence of different diseases (ALL, lymphoma, or MM) use the same standard or method (5,(15)(16)(17)(18). This is not reasonable to management of CRS of patients with B-cell hematological tumors.…”

The alveolar immune cell landscape is dysregulated in checkpoint inhibitor pneumonitis

“…Radiographic assessment was performed based on response evaluation criteria in solid tumors (RECIST); cases where the new infiltrates were deemed to represent tumor progression were excluded from both control and CIP groups. A diagnosis of CIP was adjudicated following review and discussion of the pertinent microbiologic and radiographic (11,12) data by the primary oncologist, a second oncologist (JN), 2 pulmonologists (KS, SD), and a radiologist (CTL), with additional input from other members of the immunerelated toxicity team (11) (such as radiation oncology or infectious disease), as needed. Patients in whom clinical equipoise regarding infection was present (e.g., clinical presence of fever, purulent sputum, sick populations across clusters based on their cytokine profile.…”