Abstract 5989
Background
Following the rapid expansion in the use of checkpoint inhibitors (ICIs) there has been increasing concern regarding the immune related adverse everts (irAE) associated with their usage. Whilst the efficacy is unquestionable the demand the management of patients receiving ICIs is having on oncological services is increasing and challenging in its differences to more traditional systemic anticancer therapies.
Methods
The Clatterbridge Cancer Centre established an Immuno-oncology (IO) committee early in the usage of ICIs having recognised the need to have a dedicated service for the support and management of patients receiving ICIs. This included the establishment of a toxicity management service delivered a dedicated nursing team with clinician oversight alongside the development of standard operating procedures, supporting documentation, patient and educational resources.
Results
The service was implemented with the appointment of a lead immunotherapy nurse in August 2018 and a clinical nurse specialist in October 2018. These two nurses deliver the IO toxicity service with clinical support from two medical oncology consultants and a clinical fellow. Prior to the introduction of the service, between 2016-2018, there had been 8 fold increase in the admissions due to IO. Following the introduction of the service IO admission rates have fallen by 40% over the 7 month period the service has been in place compared to the preceding 7 month period (72 vs 120 admissions). Triage calls have fallen by 16.6% and face to face reviews reduced by 9.6%. This is despite a 20% (290 vs 240 patients) increase in the number of patients commencing on ICIs in the same periods. Development of toxicity team irAE outpatient management pathways for IV therapies and a immunosuppression monitoring service have also been established.
Conclusions
A dedicated immunotherapy toxicity service has reduced the acute admissions related to irAE and is starting to reduce the activity of oncology outpatient services despite ongoing increases in ICI indications, number of administrations and complexity of combination therapies.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
This study was completed in part by a clinical research fellow (ACOB) who is currently funded by a Medical Research Council fellowship part funded by a UCB pharma, Roche, Eli Lilly and Novartis collaborative.
Disclosure
A.C. Olsson-Brown: Honoraria (self), Research grant / Funding (self): Roche; Honoraria (self), Advisory / Consultancy: Bristol-Myers Squibb; Honoraria (self): MSD ; Research grant / Funding (self): UCB Pharma; Research grant / Funding (self): Novartis; Research grant / Funding (self): Eli Lilly. T. Guinan: Honoraria (self): Bristol-Myers Squibb. S. Chow: Honoraria (self): Novartis. R. Lord: Travel / Accommodation / Expenses: AstraZeneca. J.J. Sacco: Honoraria (self), Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: immunocore. All other authors have declared no conflicts of interest.
Resources from the same session
2507 - KEYLYNK-010: Phase 3 Study of Pembrolizumab (pembro) Plus Olaparib (OLA) vs Enzalutamide (ENZA) or Abiraterone (ABI) in ENZA- or ABI-Pretreated Patients (pts) With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Who Had Progression on Chemotherapy (CTx)
Presenter: Evan Yu
Session: Poster Display session 3
Resources:
Abstract
2944 - PROSTRATEGY: A Spanish Genitourinary Oncology Group (SOGUG) multi-arm multistage (MAMS) phase III trial of immunotherapy strategies in high-volume metastasic hormone-sensitive prostate cancer.
Presenter: Jose Arranz Arija
Session: Poster Display session 3
Resources:
Abstract
3535 - A phase 1 study of AMG 160, a half-life extended bispecific T cell engager (HLE BiTE) immuno-oncology therapy targeting PSMA, in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC)
Presenter: Ben Tran
Session: Poster Display session 3
Resources:
Abstract
4951 - ProBio: An outcome-adaptive, multi-arm, open-label, multiple assignment randomised controlled biomarker-driven trial in patients with metastatic castration-resistant prostate cancer (EudraCT: 2018-002350-78, NCT03903835)
Presenter: Johan Lindberg
Session: Poster Display session 3
Resources:
Abstract
2892 - A phase 3 randomized, placebo-controlled, double-blind study of niraparib plus abiraterone acetate and prednisone versus abiraterone acetate and prednisone in patients with metastatic prostate cancer (NCT03748641)
Presenter: Kim Chi
Session: Poster Display session 3
Resources:
Abstract
2427 - The Extended/Phase II Study of Safety And Tolerability Of Proxalutamide (GT0918) In Subjects With Metastatic Castrate Resistant Prostate Cancer (mCRPC) Who Failed Either Abiraterone (Abi) Or Enzalutamide (Enza)
Presenter: Nicholas Vogelzang
Session: Poster Display session 3
Resources:
Abstract
3224 - Addition of an oral docetaxel treatment (ModraDoc006/r) to androgen deprivation therapy (ADT) and intensity-modulated radiation therapy (IMRT) in patients with high risk N+M0 prostate cancer
Presenter: Marit Vermunt
Session: Poster Display session 3
Resources:
Abstract
3312 - A phase II randomized, open-label study comparing salvage radiotherapy in combination with 6 months of androgen-deprivation therapy with LHRH agonist or antagonist versus anti-androgen therapy with apalutamide in patients with biochemical progression after radical prostatectomy.
Presenter: Piet Dirix
Session: Poster Display session 3
Resources:
Abstract
2829 - Health-Related Quality of Life (HRQoL) and Updated Follow-Up From KEYNOTE-057: Phase 2 Study of Pembrolizumab (pembro) for Patients (pts) With High-Risk (HR) Non–Muscle Invasive Bladder Cancer (NMIBC) Unresponsive to Bacillus Calmette-Guérin (BCG)
Presenter: Ronald de Wit
Session: Poster Display session 3
Resources:
Abstract
2673 - Clinical activity of vofatamab (V), an FGFR3 selective antibody in combination with pembrolizumab (P) in metastatic urothelial carcinoma (mUC), updated interim analysis of FIERCE-22
Presenter: Arlene Siefker-Radtke
Session: Poster Display session 3
Resources:
Abstract