|The following article features coverage from the 2020 ONA Virtual Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage. In addition, the original presentation is available for on-demand viewing and CNE credit until September 2021, click here to access.
The addition of immunotherapy has resulted in many improvements in oncology care in the last 10 years. Immunotherapy is a type of cancer treatment that alters the immune system to fight cancer. It has been approved for the treatment of various types of cancer. Melanoma and lung cancer are 2 common malignancies that are primarily treated with these drugs. Immunotherapy can be administered as a monotherapy, doublet therapy, or combined with chemotherapy.
Several different types of immunotherapy drugs are available: nonspecific immune stimulation (BCG, interferon), oncolytic viruses (T-VEC), adoptive cellular therapies (CAR-T), and immune checkpoint inhibitors (inhibitors of CTLA-4, PD-1, and PD-L1). Each type of immunotherapy has different characteristics, mechanisms of action, and subsequent immune-related adverse events (irAEs). Of note, irAEs can occur in up to 10% of patients receiving a single agent immunotherapy drug and in up to 20% of patients receiving a combination of immunotherapy drugs.
Immune-related adverse events affect all organ systems, fluctuate in onset and prolonged duration, and increase the risk for morbidity and mortality. The five pillars of managing immunotherapy are prevent (evaluate autoimmune risk factors), anticipate (assess for irAEs), detect (regular monitoring and reporting to physician), toxicity treatment, and monitor responses and complications.
Management is consistent with irAE grade: in cases of grade 1 irAE, continue treatment and monitor the patient closely; grade 2, hold treatment and rule out other etiologies and administer corticosteroids; grade 3 or 4, treatment is permanently discontinued, rule out other etiologies, and administer corticosteroids. Discontinue corticosteroids with a slow taper.
Despite its benefits, immunotherapy has some known disadvantages. Immunotherapy drugs have a slower onset than traditional chemotherapy medications. These drugs are extremely expensive, many of them cost more than $10,000 per dose, and patients are at risk for life threatening immune-related adverse events. In addition, we know that immunotherapy does not work well across all cancer types. Research on the use of immunotherapy in oncology care is ongoing. Melanoma is the fifth most common cancer among men and the sixth most common cancer among women nationwide. Prior to immunotherapy, patients with metastatic melanoma survived less than 6 months. Lung cancer is the second most common cancer in both men and women. More people die as a result of lung cancer each year than from breast, colorectal, and prostate cancers combined. With the addition of immunotherapy in both melanoma and lung cancer treatment, many patients with advanced-stage cancers are seeing long-lasting remissions and longer survival rates.