Based on recent combination studies of multiple IO's, it is clear that combining IO’s increased adverse event profiles.
His key points on side effects and the discussion with patients:
1) It is NOT feasible or practical to explain every possible side effect with patients
2) Key is to educate patients to contact prescribing physician with concerns is important
- Not PCP or ER doctor, as they may not be familiar with drug and side effects
- Medical Oncologist must be available to address these concerns
3) Patients should know who to call 24/7, 365 days a year – they rarely happen during office/clinic hours!
4) Those taking the calls should be experienced with immunotherapy administration and management
In terms of discussing side effects and putting it into context, some key points were:
1) The downside (side effects) need to be balanced against benefits (survival, etc)
2) Context is critical! – side effects in stage 3 healthy patient vs. side effects in stage 4 unhealthy melanoma patient are two very different concerns
3) In patients who are otherwise healthy and have been primarily treated, must discuss the role
- Toxicity/logistics of adjuvant therapy are discussed at population level results – until it happens to that patient!
- Patient preference is critical and vital
4) We know very little about the long-term minor side effects of IO”s as we only have a few years worth of data. More research is needed. In the meantime, do not blow off any patients’ concern.
Following this, they had an open-table discussion with the room based on questions patient advocates and audience members had.
Presented by: James Larkin, MD, Professor, Consultant Medical Oncologist at The Royal Marsden, London, Great Britain
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