Dr. Lyudmila Bazhenova, professor of Medicine and thoracic oncologist with the University of California San Diego, and active principal investigator in advanced immunotherapy-based clinical trials, highlights immunotherapy-related adverse events (AEs) for the Oncology Learning Network.
Dr. Bazhenova reports that immunotherapy is here to stay—that the breakthroughs with this class of therapy has been profound for cancer patients and specifically for this talk—non-small-cell lung cancer. She notes that immunotherapy now moves from second-line setting to first-line setting (e.g. the first treatment).
AEs & Immunotherapy
Of course, there can be any number of AEs, and Dr. Bazhenova reports that physicians should refer to resources such as the NCCN Guidelines, asthma guidelines, etc. that help explain to clinicians how to correctly manage immune-related adverse events.
What is Lacking?
According to Dr. Bazhenova, there is still a lack of knowledge—and hence uncertainty—when it comes to the use of and safety associated with use of immunotherapies on cancer patients with pre-existing autoimmune conditions, patients with HIV and hepatitis B and hepatitis C. She declares that it is “OK” to treat cancer patients with immunotherapies who have controlled autoimmune disorders but that this seemingly cautious greenlight is based on retrospective data. Hence, certain cancer patients with “controlled autoimmune disorder” can be given immunotherapy but she cautions of a 25 to 40% probability of exacerbation of the patient’s autoimmune disorder which then of course needs immediate treatment.
Specifics are Important
Dr. Bazhenova cautions that physicians should understand what type of autoimmune condition is present—this matters. She uses the example of a patient with myasthenia gravis and notes she would be “very reluctant” to administer an immunotherapy in such a situation. She offers another example of a patient with Scleroderma with present pulmonary fibrosis; in this situation she would probably not administer immunotherapy as she would “very worried” that it could trigger pneumonitis. On the safe end of the spectrum, a patient with mild, controlled rheumatoid arthritis would be a candidate for immunotherapy.
She reports medical professionals now have a prospective study assessing the safety of immunotherapy in HIV patients. She reports that “overall it is safe” but she worries about “exacerbation of multicentric Castleman disease” representing risk in this patient segment.
Call to Action: If you have been diagnosed with a form of lung cancer and are in Southern California in the San Diego area, consider trying to see Dr. Bazhenova. Also see the clinical trials she is actively involved with—or has participated in. Contact here.