A review of the advice and service provided by AOS for patients on immunotherapy at Velindre Cancer Centre


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Joanita Ocen1,Joanita Ocen2,Hayley Taylor3,Hilary Williams2
1South West Wales Cancer Centre,2Velindre Cancer Centre,3Cardiff Medical School

Abstract

Background

Immunotherapy is rapidly becoming a vital part of cancer treatment. Immune checkpoint inhibitors (ICPis) have recently had an enormous amount of clinical success, being approved in a number of different tumour sites over the last few years. Due to the way in which these drugs inhibits suppression if the autoimmune system, ICPis pose a distinct profile of side effects compared to chemotherapy agents. For acute oncology services (AOS) these toxicities present new and challenging problems that need to be recognised early, and dealt with effectively.

Method

We carried out a retrospective review of 257 phone calls from 01/03/2017 to 28/02/2018. Where could we compared the advice given against our cancer centre immunotherapy toxicity management guidelines. 

Results

Results: The most common irAE was diarrhoea/colitis; 26.4% (n=28) of all irAEs. Of 1008 ICPi cycles given, 1.5% (n=15) resulted in a grade 3-4 toxicity picked up via the AOS treatment helpline (of which 53.3% were reviewed acutely), with 0.2% (n=2) being grade 4. 60.7% (n=17) of diarrhoea/colitis calls were managed according to VCC immunotherapy toxicity guidelines, and immunotherapy was stopped/deferred/continued appropriately in 92.9% (n=26) of cases. 33.3% (n=16) of calls marked ‘urgent review’ were immune-related, and on average, time between the last ICPi and helpline call was 18 days. Average length of admission after an urgent review was 6 days.

Conclusion

Conclusion: Immunotherapy does have quite an impact hospital services as patients can be admitted for many days. Although adherence to the guidelines was variable and did not reach the 100% target, clinical discretion will have been an important influencing factor. With improved triage and data management, the AOS treatment helpline will continue to improve management of irAEs at VCC. It is clear that with on going use of these relatively new treatments, staff education and updates on management guidelines are key for the future.