She kicked off the session by laying the groundwork of terminology and basic knowledge, so everyone was on the same page. She wants every physician to understand that it is NO longer reasonable to expect that patients won’t have looked up stuff on google prior to seeing you – in fact, it is better to help them search appropriately by giving them necessary information so that they can be better informed. My two favorite slides from her are:
and
To understand immune checkpoint inhibitors, you have to start by explaining the immune system. At its very basic, it is a system that enables human bodies to identify SELF vs. FOREIGN. The key mediators of this are natural killer T-cells.
Checkpoint inhibitors are a new set of medications that help modulate this system. She explains it to her patients as a car – as its easily related. An immune system, like a car, has an accelerator and a brake. It is normal, for example in the setting of an infection, to hit the accelerator, then when the infection clears, to hit the brake. But, in cancer, the brake is being held down, so the immune system car can’t accelerate. So, immune checkpoint inhibitors are like a piece of wood or a stone that is put behind the brake so it can’t get held down – and while different ICI’s maybe like wood or stone, they all function the same way.
She basically reviewed the concept of TNM staging – T gives info regarding the tumor, N regarding the nodal disease (and you need to explain lymph nodes and lymphatic system to the patient usually) and M regarding the other sites in the body. Staging systems are different from tumor to tumor – so it cannot broadly be applied.
- She often refers her patient to the AJCC website
Presented by: Bettina Ryll, MD, Chair ESMO Patient Advocates Working Group (PAWG), Uppsala, Sweden
Written by: Thenappan Chandrasekar, MD, Clinical Instructor, Thomas Jefferson University, twitter: @tchandra_uromd, @TjuUrology at the 2018 European Society for Medical Oncology Congress (#ESMO18), October 19-23, 2018, Munich Germany