Immunotherapy Program Ready to Tackle Cancer Side Effects

Sylvester Comprehensive Cancer Center’s Immune-Related Adverse Events program takes on cases of patients with strong side effects from immunotherapy.

As cancer therapies have advanced significantly during the last decades, there can still be harsh side effects from treatment, as in the case of immunotherapy.

While this may be a stressful outcome to an already difficult disease, Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, has a team of specialists ready to tackle these cases, thanks to its Immune-Related Adverse Events (irAE) program.

Sylvester’s irAE program launched in the fall of 2022 as a web-based clinic team led by Jose Lutzky, M.D., director of cutaneous oncology and director of the irAE program. Together with a group of oncology subspecialists from the NCI-designated cancer center, the program consists of a collaborative approach to cancer care for patients having side effects from immunotherapy.

“We are one of the few unique irAE programs in the country and the only one in South Florida,” Dr. Lutzky said. “Here, our main focus is patient safety, as we are making sure to address these immunotherapy side effects early and prevent unnecessary hospitalizations, ER visits and even deaths.”

Why Immunotherapy Side Effect Occur in Cancer Patients

Implementing immunotherapy as a cancer treatment began in 2011 when it received FDA approval as a therapy for melanoma. The drug used in this approval was an immune checkpoint inhibitor, shown to work well by allowing the body to recognize cancer cells so its T cells can destroy the tumor.

This successful therapy is administered via IV every few weeks, as prescribed, either as a standalone therapy or combined with other immunotherapy drugs or chemotherapy. At Sylvester, nearly 600 patients a month are using this treatment in cancers apart from melanoma.

“I would say that today, 80 to 90% of all cancers probably use some form of immunotherapy,” Dr. Lutzky said. “Our immune system works by causing inflammation, which leads to killing the tumor cells. In the process, inflammation in different organs is also responsible for most of the side effects we see with immunotherapy.”

One of these types of inflammation is known as cytokine storm, an aggressive autoimmune response to the body’s fight against infections. This condition can happen when certain illnesses are present, such as the flu, but also occur as a response to some immunotherapies.

Common side effects from immunotherapy also include hepatitis, colitis and extreme fatigue, as the body can mistakenly attack healthy cells during immunotherapy administration. Patients at higher risk for side effects tend to be those with existing immune disorders, such as lupus, or those with cancers that require more potent immunotherapy combinations.

More complications arise as many oncology providers still need to adapt to proper treatment strategies for these side effects, which can result in prolonged hospital stays and unnecessary medications, according to Estelamari Rodriguez, M.D., M.P.H., a breast, medical and thoracic oncologist at Sylvester.

“Immunotherapy has revolutionized the management of patients with lung cancer, but it has also opened the door for other side effects that many lung specialists had never managed before,” Dr. Rodriguez said. “Having access to irAE subspecialists in the group who are experts on managing these complications has allowed me to provide better care to my patients and handle IR side effects early before they become serious complications.”

Team Science at Sylvester Comprehensive Cancer Center

Sylvester’s irAE program works through collaborative approaches from all aspects of the care team. Patients undergoing immunotherapy at Sylvester are asked about symptoms and discomfort levels, which triggers contact to the irAE management team, if further action is needed.

Through a secure chat application in Sylvester’s EPIC software, online conversations will occur between the irAE team and the patient’s providers on a case-by-case basis. The oncologists in the chat analyze the patient’s reported symptoms and treatment plans are discussed. This behind-the-scenes conversations precedes the primary oncologist and nurse delivering the final care plan.

While the program is still new, it continues to grow as more cancer providers become aware of its purpose. Future implementations involve training oncologists on spotting and accommodating patients with side effects due to immunotherapy and establishing the routine of using the irAE program. From there, home monitoring devices will aid patients with severe side effects by tracking vital signs, oxygen and blood levels, especially in older patients.

“The program not only offers evidence-based treatment recommendations but also facilitates expedited appointments for specialized diagnostic procedures and management,” said Leonel Hernandez Aya, M.D., oncologist at Sylvester and assistant professor at the Miller School. “Timely access to subspecialists ensures that these side effects are diagnosed and treated promptly, often leading to more effective treatment and better outcomes.

Tags: Dr. Estelamari Rodriguez, Dr. Jose Lutzky, Dr. Leonel Hernandez Aya, immunotherapy, Sylvester Comprehensive Cancer Center, USNWR Oncology