The first consensus recommendations on recognition and clinical management of immune-related side effects from cancer immunotherapy are published today in the Journal for ImmunoTherapy of Cancer (JITC). The article, Managing toxicities associated with immune checkpoint inhibitors: Consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group, is a key step toward ensuring patients with cancer receive the highest quality of care.
Cancer immunotherapy -; treatment that harnesses the patient’s own immune system to recognize and fight cancer -; has become a pillar of cancer care in recent years. One widely used class of agents, checkpoint inhibitors, works by “taking the brakes off” the immune system, allowing cancer cells to be targeted for destruction. Clinical trials have shown that checkpoint inhibitors are highly effective, providing long-term benefit with generally manageable side effects. However, patterns are emerging that suggest that checkpoint inhibitors may cause unwanted effects in a number of organ systems.
When caught early, most side effects are mild and can be treated with drugs that temporarily suppress the immune system. Experts are therefore focused on ensuring that clinicians recognize and know how to manage these emerging side effects so patients can continue to take advantage of the unquestionable benefits of immunotherapy.
As the leading professional society in the field, the Society for Immunotherapy of Cancer (SITC) established a multidisciplinary expert group to address this unmet need. Medical oncologists, surgeons, disease specialists, scientists, pharmacists, nurses, and others with relevant expertise convened to develop guidance on managing adverse effects from checkpoint inhibitors. Describing the urgent need, medical oncologist Igor Puzanov, MD, MSCI, FACP, Chief of Melanoma and Director of the Early-Phase Clinical Trials Program at Roswell Park Cancer Institute, one of four co-leads, explained, “New immunotherapy agents are being approved at a rapid pace. We’re excited that patients have new treatment options but many of these agents have side effects we haven’t seen before. We’re seeing effects on the skin, lungs, gastrointestinal and endocrine systems, joints, heart and other organs, and some of these are only just beginning to be described. Clinicians need guidance on how to recognize early signs, how to treat adverse effects, and when to refer to a disease specialist.”
Leading the SITC initiative, Dr. Puzanov and Marc Ernstoff, MD (Roswell Park Cancer Institute, NY), Howard L. Kaufman, MD, FACS (Massachusetts General Hospital, MA) and Adi Diab, MD (University of Texas MD Anderson Cancer Center, TX) made it a priority to align recommendations across organizations.
Immediate SITC Past President Howard L. Kaufman explained, “These guidelines provide the best consensus thinking in this rapidly developing area of tumor immunotherapy. I am especially proud of our strategic partners, ASCO and NCCN, who contributed to the development of this important resource, and whose leadership will help harmonize the approach to patient management, allowing optimal therapeutic benefit while maintaining the highest quality of life for patients with cancer.” Guidance will be further aligned by the involvement of SITC leaders in the development of ASCO and NCCN guidelines.
This is a dynamic effort and recommendations will evolve and be updated as new data, and new drugs and combinations, become available.