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Educating the  Mesothelioma Medical Community About Immunotherapy Side Effects


Immunotherapy is gaining traction as a treatment for mesothelioma patients. Patients who respond to the treatments have had months, and in some cases, years, added to their lives. However, like many mesothelioma cancer treatments, immunotherapy comes with side effects. Now, the American Society of Clinical Oncology (ASCO) has released guidelines for managing adverse events in patients treated with immunotherapy.

A panel of experts from medical fields including oncology, gastroenterology, rheumatology, pulmonology, emergency medicine, and nursing came together to review literature, trial data and case studies published between 2000 and 2017. Using this information, along with their expertise, the team developed the recommendations for immune-related adverse events in patients treated with immune checkpoint inhibitor (ICPi) therapy.

The recommendations offer suggestions for managing toxicities in patients undergoing ICPi therapy ranging from monitoring patients with grade 1 toxicities to “permanent discontinuation” for patients with grade 4 toxicities.

“Immunotoxicities are typically ones that we’re seeing when we treat patients with PD-1 or PD-L1 inhibitors that are now approved for use in the community,” said Julie Brahmer, MD, of the Bloomberg Kimmel Johns Hopkins Institute for Immunotherapy in Baltimore, in a June 27 interview with MedPage Today. “Really, we need some framework around how to manage such patients.”


Immunotherapy and Mesothelioma

PD-L1, or programmed death-ligand 1, is a protein that has been shown to play a role in suppressing the immune system during cancer and other diseases. Keytruda and Opdivo are two FDA-approved PD-L1 inhibitor immunotherapy drugs that stimulate the patient’s immune system to attack the cancer and target the PD-1/PD-L1 cellular pathways.

Keytruda has shown to be effective in controlling mesothelioma tumors in various clinical trials. Mavis Nye of England, a nine-year mesothelioma survivor, claimed remission from her pleural mesothelioma after participating in a two-year clinical trial of Keytruda. Mesothelioma is caused by past exposure to asbestos.

Mesothelioma is an incurable asbestos-caused cancer that is both rare and aggressive. Standard treatment often consists of chemotherapy, surgery when appropriate, and radiation. Survival is usually just one year.

Read about two companies working together to improve immunotherapy response.

The ASCO authors noted that “patient and family caregivers should receive timely and up-to-date education about immunotherapies,” and how they work, prior to beginning any treatment.

They also noted that ICPi use is associated with a spectrum of adverse effects “that is quite different from other systemic therapies such as cytotoxic chemotherapy.” As such, they report, “there should be a high level of suspicion that new symptoms are treatment related.”

Dr. Brahmer says, the guidelines tell us “how to actually monitor patients while on treatment for these types of toxicities and how to educate patients as well as other providers you work with in the community.” According to ASCO, the clinical practice guidelines “serve as a guide for doctors and outline appropriate methods of treatment and care.”

Nearly 3,000 Americans are diagnosed with mesothelioma each year. As Mesothelioma Help has reported many times, immunotherapy is moving to the forefront of mesothelioma care, and guidelines such as these are important as oncologists learn more about the treatment.

Mesothelioma patients should partner with their doctor to ensure the treatments are appropriate for them.

Read the full set of guidelines in the Journal of Clinical Oncology.


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