Algorithm Improves Adverse Event Response for Patients Receiving Immunotherapies

A standard algorithm created by a nurse-led collaborative team helped clinicians better assess and manage adverse events in patients receiving immunotherapy for cancer, according to an oral presentation at the Oncology Nursing Society Annual Congress (April 29-May 1, 2016; San Antonio, TX).

Immunotherapies have shown great promise for the treatment of cancer; however, the adverse events associated with these treatments can be different from what is seen with other therapies.
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At the Oncology Nursing Society meeting, RuthAnn Gordon, MS, FNP-BC, OCN, Memorial Sloan-Kettering Cancer Center (New York, NY [MSKCC]), discussed a process for improving provider response to immune-related adverse events (irAEs) through the creation of a unique algorithm.

The algorithm, said Ms Gordon, starts with a review of signs and symptoms associated with treatment, leading to a classification as a reaction of the skin (dermatitis), the gastrointestinal system (enterocolitis), the liver (hepatitis), the endocrine system, or the lungs (pneumonitis). The severity of the responses are then determined using an appropriate laboratory test and patient assessment, applying National Cancer Institute Common Terminology Criteria for Adverse Events guidelines.

Ms Gordon continued that it is important to differentiate other causes for symptoms from those related to immunotherapy use. In circumstances in which the cause for a symptom is not immune-related, it is best to continue with immunotherapy. When symptoms are directly attributable to immunotherapy treatment, the strategy should be to evaluate the severity of the symptoms and determine the best intervention.

At MSKCC, the Start, Pause, Stop principle is used to assess treatment response. With this method, once a patient reports a side effect, symptoms are reviewed and assessed. If the irAE is categorized as grade 1, appropriate symptomatic treatment is administered while immunotherapy is continued with close monitoring and follow-up.

If the irAE is assessed as grade 2, a pause in immunotherapy is considered while symptoms are treated. When symptoms subside, treatment is slowly resumed over a 2- to 4-week period.

For grade 3 irAEs, immunotherapy is stopped while symptoms are treated. When those are fully resolved, clinicians make a decision of whether it is safe to resume or stop immunotherapy.

The detection, assessment, and treatment of irAEs are essential to ensuring high quality outcomes for patients and avoiding potentially life-threatening adverse events, concluded Ms Gordon. The algorithm developed and implemented at MSKCC provides one framework by which clinicians can efficiently manage these in patients receiving anticancer immunotherapies.