Though the majority of immune-related adverse events (irAEs) can be managed with corticosteroids and other immunosuppressive treatments, life-threatening and sometimes fatal events have still been reported thus revealing a need to develop measures for effective management.
In a paper published in the Journal for ImmunoTherapy of Cancer, researchers investigators proposed a variety of strategies seeking to improve the management of immune-related adverse events (irAEs) brought on by immune checkpoint inhibitors.
Distinct from conventional cancer treatments that act on tumor growths directly, immune checkpoint inhibitors work by restoring the suppressed immune system in order to attack tumor cells. Nonetheless, by disrupting the homeostatic mechanisms that balance immune cell functions, immune checkpoint inhibitors prompt irAEs in a significant proportion of patients.
Though the majority of irAEs can be managed with immunosuppressive treatments, life-threatening and sometimes fatal events have still been known to occur in patients receiving these therapies. Moreover, without predictive biomarkers to determine which patients are at risk for irAEs or standardized approaches for detection, reporting, and treatment of irAEs, management has proven challenging. These factors taken together suggesting a need to develop strategies that will improve the handling of irAEs.
Importantly though, the incidence of irAEs is largely dependent on the type of immune checkpoint inhibitor used; for example, patients treated with the CTLA-4 inhibitor ipilimumab (Yervoy) experience irAEs at a rate of up to 70% versus around 30% for those treated with a PD-1 inhibitor. The highest incidence of events has been reported in those receiving the CTLA-4/PD-1 inhibitor combination of ipilimumab plus nivolumab (Opdivo). Similarly, the severity and type of irAEs differs with each checkpoint inhibitor used.
“With increasing use of [immune checkpoint inhibitors] for treatment of various cancers, the incidence of irAEs will undoubtedly increase,” the study authors who were led by Aung Naing, MD, wrote in their paper. “There is a compelling need to develop measures to effectively manage irAEs, both in the community settings and in cancer centers alike.”
In order to address the current unmet need in this area, investigators recommended a variety of measures for the effective management of irAEs including. Strategies recommended for the effective management of irAEs included:
“By adopting strategies such as listening to patients’ voices, conducting preclinical, clinical, and translational studies to identify predictive markers of irAEs, and developing evidence-based irAE management guidelines, we can minimize the toxic effects of [immune checkpoint inhibitors] while achieving the full therapeutic potential of these drugs,” concluded the authors.
Naing A, Hajjar J, Gulley JL, et al. Strategies for improving the management of immune-related adverse events. Journal for ImmunoTherapy of Cancer 2020;8(2):e001754. doi:10.1136/jitc-2020-001754