Immunotherapy with immune checkpoint inhibitors
has revolutionized treatment for many different
types of cancer by unleashing the body's immune
system to attack cancer. These therapies can send
even the most hard to treat cancers into lasting
remission. But these treatments also come with
unique side effects that can effect multiple organs in the body,
and because these treatments have entered the clinic fairly recently,
many clinicians are not experienced in
recognizing and treating the side effects.
This is why the American Society of Clinical Oncology
and National Comprehensive Cancer Network
have collaborated on guidelines that
offer clinicians much needed recommendations for
assessment and treatment of side effects related to immune checkpoint inhibitors.
The major strength of the guidelines is to
identify and manage side effects when they are
just beginning, and therefore, much more manageable.
As immunotherapy starts getting into the community more and more, and we're treating more and more
patients with these type of drugs, then trying to
figure out how best to manage their side effects
would be very important as well as education
of both patients, as well as caregivers and the
physician and extended team. The widespread use of immunotherapy
is moving into standard clinical practice for
lung cancer, for melanoma, for bladder cancer,
for Hodgkin's disease, and therefore, these agents are beginning
to be widely used. They have a very different spectrum of side effects.
While fatigue is very common on immunotherapy as it is also with
chemotherapy, the immune therapy tends not to have
direct side effects on the bone marrow,
patients tend not to lose their hair, so the
mechanism of action of immunotherapy is very
important to know because that can help guide you
about 1) how to treat side effects that occur on
immunotherapy, but also how to be aware of
these types of side effects that can come up.
With the immune checkpoint inhibitors, we are removing the
brake pedal from the immune system. Those brake systems
are there for a reason; that is to
prevent our immune system from attacking itself.
So when we remove those safety mechanisms from
our system, we encounter all kinds of side
effects that could be described as autoimmune side effects.
Patients are living a lot longer with immunotherapy. We're now facing the chronic
toxicities of these drugs and how to manage them,
so that's an important concept that we need to
understand and need to approach in a very logical and sequential way.
We're seeing more and more cases of toxicity
that result from these treatments, and so the guidelines are intended to address how to
diagnose, recognize, and treat the side effects of
immune checkpoint inhibitor therapy.
It is the goal of ASCO and NCCN guidelines
to improve patient care by making
clinicians aware of the side effects of immune checkpoint inhibitors
and to guide them on how to best manage them.
