Practices for the management of immune-mediated adverse events (IMAEs) with the use of immune checkpoint inhibitor (ICI) therapy at a hospital network system were evaluated in a study. The study’s results were published in the Journal of the Advanced Practitioner in Oncology.
ICI therapy has led to advances in survival for responders to this therapy approach. However, the possibility of developing IMAEs during or after ICI treatment led the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) to provide joint guidelines for IMAE management in February 2018.
“Due to the complexity of IMAEs and the potential for differing prescribing practices, there is likely discordance between guideline recommendations and actual clinical practice due to prescriber preference and clinical experiences,” the study investigators explained in their report. They developed this study to determine the adherence of current prescribing practices within the Allegheny Health Network, as well as the efficacy of corticosteroid treatment in managing IMAEs, in addition to other aims.
Continue Reading
The study was a retrospective chart review of patients in this health network who had been treated for cancer with ICI therapy and who had ICI-related IMAEs treated with corticosteroids. The chart review occurred from February 2016 through July 2018, which spanned the time during which the NCCN and ASCO released joint guidelines on IMAE management.
The study evaluated data from 81 patients who had a median age of 62.4 years. The most common IMAEs in this population included colitis (28%), pneumonitis (27%), and skin-related inflammation (12%). In 62% of cases, the investigators reported a discordance with guideline recommendations. Overall, 94% of patients experienced resolution of the IMAE, and 54% resumed ICI treatment. However, among patients who resumed ICI therapy, approximately one-third (34%) had IMAE recurrence.
Discordance with guideline recommendations involved a few prescribing practices. One practice deviation involved use of an inappropriate starting dose of corticosteroid therapy (64%). Other practice deviations concerned steroid taper approaches, including initiation of a corticosteroid taper before IMAE resolution to a sufficiently low grade (38%) and the use of a condensed corticosteroid taper (74%). A less common prescribing deviation was the resumption of immunotherapy prior to being on a dose of less than 10 mg prednisone-equivalent (8%).
The investigators noted that IMAE management that occurred prior to the release of the joint guidelines may not have been inappropriate according to practices at that time. “Although not specifically reported in this study, data for both primary and secondary study outcomes largely reflected greater conformance to NCCN and ASCO guideline recommendations, particularly for patients managed after February 2018,” the investigators wrote in their report.
The investigators concluded that for approximately two-thirds of patients in this study who received corticosteroids, treatment was discordant with NCCN and ASCO guideline recommendations. They also emphasized the need for appropriate management of IMAEs in the context of ICI therapy.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Tsui A, Edmondson L, Julius J. An evaluation of the use of corticosteroids for the management of immune-mediated adverse events in cancer patients treated with immune checkpoint inhibitors. J Adv Pract Oncol. 2021;12(2):137-145. doi:10.6004/jadpro.2021.12.2.2
