Johns Hopkins Kimmel Cancer Center completed a pilot study suggesting institutions and networks that utilize immunotherapy as a treatment for cancer should consider establishing multidisciplinary teams for providing central, coordinated services for diagnosis and management of immunotherapy-related adverse events (irAEs).
Published recently in the Journal of the National Comprehensive Cancer Network, the team compiled a team of subspecialists across a variety of disciplines, who agreed to be contacted through a password-protected email system. The team members replied to questions within 24 hours to provide the necessary feedback and referrals for the treatment of various irAEs.
Researchers were surprised by the success of this pilot program. During the eight month period, there were 117 referrals regarding 102 different patients, with all providers receiving toxicity management recommendations within 24 hours.
The team included eight medical oncologists, four oncology nurses, four specialists in rheumatology, three in pulmonology (two each in neurology, endocrinology, dermatology and ophthalmology and one in cardiology, hematology and infectious disease). The agreed-upon time commitment was four to six hours per week for central members and two to four hours for other specialists.
The service was so effective that all of the 57 providers who responded to a post-pilot survey reported using all or some of the recommendations they received. 73.5% of referring providers said they changed their diagnostic evaluation or management of an immune-related toxicity as a result of the recommendations from the team.
John A. Thompson, MD Seattle Cancer Alliance, Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Management of Immunotherapy-Related Toxicity reported “The immune checkpoint inhibitors (ICIs) have revolutionized medical oncology; ICI therapy induces objective responses and brings improved survival to patients with a variety of cancers. However, ICI therapy may trigger autoimmune side effects that bring inflammation and damage to virtually any tissue or organ.”
Although he was not in the study, he continued saying “Healthcare providers in all specialties are now encountering patients with these toxicities for the first time and are looking for expert, actionable advice in real time. The Multidisciplinary ICI-Toxicity Consult Services described in the paper is an important new resource to support education and best-practice care, and to study these treatment-related concerns.”
Jarushka Naidoo, MBBCh, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins