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Guidelines Clarify Management of Immune-Related AEs in Lung Cancer

Danielle Bucco
Published: Wednesday, Mar 14, 2018

Heather Greene, NP
Heather Greene, NP
Immunotherapy has taken over the conversation for oncologists when discussing treatments for patients with lung cancer, explains Heather Greene, NP. The class of agents has been generally well tolerated in this patient population; however, there are adverse events (AEs) associated with this treatment strategy that require close monitoring, she adds.

State of the Science Summit™ on Advanced Non–Small Cell Lung Cancer, Greene, a nurse practitioner at West Cancer Center, discussed the safety profile for patients with lung cancer receiving immunotherapy, and the importance for reporting these immune-related AEs.

OncLive: Can you provide an overview of your presentation on the side effect profile of immunotherapy for patients with lung cancer?

Greene: Immunotherapy is an important conversation that oncologists are having. It is dominating the oncology world right now. From a nurse practitioner standpoint, we are on the frontlines and there are many important things that people should be aware of.

It is important to make sure that we are identifying these immune-related AEs early on so that we can intervene quickly. That will allow for the best outcomes for our patients. These immune checkpoint inhibitors are well tolerated and the side effects are usually mild. However, they can have an insidious onset and become life-threatening if we do not know how to identify them and intervene in a timely fashion.

What are the most common AEs that patients experience with immunotherapy?

Technically, immune-related AEs can happen anywhere in the body, but we tend to see them most commonly on the skin [and in the] gastrointestinal tract, and the endocrine system. There are a few rare side effects, such as pneumonitis and nephritis. We need to get some of our consultants involved in terms of helping us identify and delineate these immune-related events because they can sometimes be hard to differentiate between other symptoms and true immune-related events.

Do these tend to be different between agents? Would AEs from a PD-1 inhibitor be different from a PD-L1 inhibitor or a CTLA-4 inhibitor?

They tend to be lumped together as immune checkpoint inhibitors. In terms of patients with non–small cell lung cancer (NSCLC), we tend to focus on the PD-1 and PD-L1 AEs, which are generally the same. They tend to have the same side effect profiles. We do see some increase in toxicity when those agents are combined, since we combine PD-L1 inhibitors and CTLA-4 inhibitors. However, they are fairly similar

Can you speak to the prevalence of the rarer AEs?

In some of the initial lung cancer trials, we did not see a lot of AEs. When we did see them, they were mild grade 1 or 2 events with very few grade 5 events. They are very uncommon. We saw less than 1% of patients in many pivotal trials have those AEs. Again, they can be life-threatening, so it is something that we need to keep our eye on.

Is there any way to tell how a certain patient is going to tolerate an immunotherapy?

There is a lot of research looking at biomarkers to help clinicians identify who might be better candidates for immunotherapy than others. There is controversy over a tumor testing positive for PD-L1 and whether they have a better response to PD-1 or PD-L1 inhibitors. Sometimes you get a different answer with each article that you read. There is not a good consensus at this point.

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Online CME Activities
TitleExpiration DateCME Credits
Online Medical Crossfire®: 5th Annual Miami Lung Cancer ConferenceMay 30, 20196.5
Community Practice Connections™: Practical Application of Sequencing for EGFR-Mutant Lung Cancers: A Focus on Recent Evidence and Key Next Steps in TrialsJun 29, 20192.5
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