Multidisciplinary approach for improvement of immunotherapy utilization in solid tumors with H MSI /dMMR –An action plan from a single oncology center

2021 ◽  
Vol 3 (1) ◽  
pp. 1-5
Author(s):  
Nagwa Ibrahim ◽  
Muneerah Alzouman ◽  
Abdulaziz Alhamad ◽  
Muneera AlMajed ◽  
Mohamed Almeziny ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mismatch Repair ◽  
Solid Tumors ◽  
Immune Checkpoint Inhibitors ◽  
Best Practice ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Action Plan ◽  
Oncology Center ◽  
Practice Patient

Immune checkpoint inhibitors such as nivolumab and pembrolizumab are approved by Food and Drug Administration for patients diagnosed with metastatic solid tumors with high microsatellite instability (MSI) or mismatch repair deficient (dMMR). The prognosis of these patients is generally poor, that is why it is very essential to identify the targeted patients who can benefit from immunotherapy. Pembrolizumab is approved in our institution for this indication. In order to ensure proper utilization of available resources, we decided to make a pilot retrospective review to evaluate pembrolizumab utilization, to identify the problems we are facing then to set an action plan through multidisciplinary approach. Based on the results we set recommendations. This paper is innovative and the first in kind. It could be used as guidance for other centers using immunotherapy and could be applied for other drugs as well to ensure best practice, patient safety and maximize utilization of resources.

scholarly journals A real‐world data of Immune checkpoint inhibitors in solid tumors from India

2021 ◽  
Author(s):  
Vanita Noronha ◽  
George Abraham ◽  
Vijay Patil ◽  
Amit Joshi ◽  
Nandini Menon ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Real World ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Real World Data ◽  
World Data

Incidence and Economic Burden of Infections in Cancer Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Swarna Nalluru ◽  
Paramrajan Piranavan ◽  
Anvesh Narimiti ◽  
Ahmad D. Siddiqui ◽  
George M. Abraham
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Economic Burden ◽  
Immune Checkpoint ◽  
Average Cost ◽  
Immune Checkpoint Inhibitors ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Antitumor Effects ◽  
Cost Per Admission

Abstract BACKGROUNDAlong with antitumor effects, Immune Checkpoint Inhibitors (ICPI) have shown great potential in treating chronic infections such as HIV, Hepatitis B and malaria, in ex-vivo studies. However, several case reports and case series have suggested an increased infection risk in cancer patients. The purpose of our study was to assess the risk of infections in cancer patients receiving ICPI. We also attempted to evaluate the role of a multidisciplinary approach (Oncology and Infectious disease specialists) and the cost associated with treatment. METHODS:Records on all cancer patients over age ≥18 years old who had received at least one dose of ICPI between 2015 to 2018 at a major community teaching hospital in the central Massachusetts region were reviewed. Several risk factors associated with infection were identified. A two-tailed, unpaired t-test was used to analyze the association between risk factors and infection. We calculated the cumulative length of stay (LOS) and cost per admission with a multidisciplinary vs. non-multidisciplinary approach. The calculated total average cost per admission was compared to a matched population (without an oncologic diagnosis) admitted with infections similar to that in our study, to compare the economic burden. RESULTSRetrospective chart review of 169 cancer patients receiving ICPI showed sixty-two episodes of infection in thirty-seven (21.8%) patients and a mortality rate of 3.5% due to associated complications. Risk factors like COPD, prior chemotherapy and steroid use were significantly associated (P<0.05) with infections. Further sub-group analysis showed increase in cumulative LOS from 5.9 to 8.1 days but approximately similar average cost per admission ($52,047 vs. $54,510) with non-multidisciplinary vs. multidisciplinary approach. The calculated total cost per admission during an episode of infection in this cohort of patients was $35,484; three-fold higher when matched to similar infections in a general non-oncologic population ($11,527). CONCLUSIONSA significant incidence of infections and associated health care resource utilization continues to prevail in cancer patients despite the utility of ICPI. A multidisciplinary approach to manage the infections and associated complications in cancer patients receiving ICPI increased the cumulative LOS but not the average cost per admission.

scholarly journals Immune Checkpoint Inhibitors in pMMR Metastatic Colorectal Cancer: A Tough Challenge

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2317 ◽  
Author(s):  
Federica Marmorino ◽  
Alessandra Boccaccino ◽  
Marco Maria Germani ◽  
Alfredo Falcone ◽  
Chiara Cremolini
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Mismatch Repair ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Dna Mismatch Repair ◽  
Checkpoint Inhibitors ◽  
Favorable Effect ◽  
Mutational Load ◽  
Dna Mismatch

The introduction of checkpoint inhibitors provided remarkable achievements in several solid tumors but only 5% of metastatic colorectal cancer (mCRC) patients, i.e., those with bearing microsatellite instable (MSI-high)/deficient DNA mismatch repair (dMMR) tumors, benefit from this approach. The favorable effect of immunotherapy in these patients has been postulated to be due to an increase in neoantigens due to their higher somatic mutational load, also associated with an abundant infiltration of immune cells in tumor microenvironment (TME). While in patients with dMMR tumors checkpoint inhibitors allow achieving durable response with dramatic survival improvement, current results in patients with microsatellite stable (MSS or MSI-low)/proficient DNA mismatch repair (pMMR) tumors are disappointing. These tumors show low mutational load and absence of “immune-competent” TME, and are intrinsically resistant to immune checkpoint inhibitors. Modifying the interplay among cancer cells, TME and host immune system is the aim of multiple lines of research in order to enhance the immunogenicity of pMMR mCRC, and exploit immunotherapy also in this field. Here, we focus on the rationale behind ongoing clinical trials aiming at extending the efficacy of immunotherapy beyond the MSI-high/dMMR subgroup with particular regard to academic no-profit studies.

scholarly journals Association of immune-related adverse (irAEs) with immune-checkpoint inhibitors (ICIs) efficacy in solid tumors

2018 ◽  
Vol 29 ◽  
pp. viii427
Author(s):  
M. Riudavets Melia ◽  
L.P. del Carpio ◽  
I. Gabriela Sullivan ◽  
A. Barba Joaquín ◽  
P. Maroto Rey ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors

Immunotherapy in Gynecologic Cancers: What We Know Now and Where We Are Headed

2019 ◽  
pp. e126-e140 ◽  
Author(s):  
Kimberly Levinson ◽  
Oliver Dorigo ◽  
Krista Rubin ◽  
Kathleen Moore
Keyword(s):  
Solid Tumors ◽  
Solid Tumor ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Gynecologic Cancer ◽  
Hematologic Malignancies ◽  
Next Generation ◽  
Gynecologic Cancers ◽  
Clinical Benefits

Immunotherapy, mainly in the form of immune checkpoint inhibitors (ICIs), has been transformative in both solid tumor and hematologic malignancies. Patients with previously terminal illnesses have experienced profound responses of great durability with these agents, fueling excitement among patients and providers regarding their use. Unfortunately, the gains seen in some solid tumors have not been replicated in a large percentage of patients with gynecologic cancer. This review focuses on the clinical benefits seen to date, toxicities and management when using ICIs, ways to improve prediction of who should receive immunotherapy, and a discussion of next-generation immunotherapy with cellular therapeutics and how these might relate to gynecologic cancers.

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