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
1885 - Factors associated with disease progression in patients treated with trametinib in combination with dabrafenib for unresectable advanced BRAFV600-mutant melanoma: an open label, non randomized study
Presenter: Philippe Saiag
Session: Poster Display session 3
Resources:
Abstract
5259 - Integrative RNAseq and Target panel sequencing reveals common and distinct innate and adaptive resistance mechanisms to BRAF inhibitors
Presenter: Phil Cheng
Session: Poster Display session 3
Resources:
Abstract
5619 - Effective treatment with T-VEC monotherapy in Stage IIIB/C-IVM1a Melanoma of the Head & Neck Region
Presenter: Viola Franke
Session: Poster Display session 3
Resources:
Abstract
5666 - Re-introduction of T-VEC Monotherapy in Recurrent Stage IIIB/C-IVM1a melanoma is effective
Presenter: Viola Franke
Session: Poster Display session 3
Resources:
Abstract
4117 - Efficacy of talimogene laherparepvec (T-VEC) in melanoma patients (pts) with locoregional (LR) recurrence, including in-transit metastases (ITM): subgroup analysis of the phase 3 OPTiM study
Presenter: Mark Middleton
Session: Poster Display session 3
Resources:
Abstract
5303 - Real Life Use of Talimogene Laherparepvec in Melanoma in Centers in Austria and Switzeland
Presenter: Christoph Hoeller
Session: Poster Display session 3
Resources:
Abstract
4130 - Outcomes of advanced melanoma patients who discontinued pembrolizumab (pembro) after complete response (CR) in the French early access program (EAP)
Presenter: Philippe Saiag
Session: Poster Display session 3
Resources:
Abstract
2050 - Outcome of patients with elevated LDH treated with first-line targeted therapy (TT) or PD-1 based immune checkpoint inhibitors (ICI)
Presenter: Sarah Knispel
Session: Poster Display session 3
Resources:
Abstract
1618 - Comparative-Effectiveness of Pembrolizumab vs. Nivolumab for Patients with Metastatic Melanoma
Presenter: Justin Moser
Session: Poster Display session 3
Resources:
Abstract
3556 - Long-term efficacy of combination nivolumab and ipilimumab for first-line treatment of advanced melanoma: a network meta-analysis
Presenter: Peter Mohr
Session: Poster Display session 3
Resources:
Abstract