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AEs With ICI/Targeted Tx

CE / CME

Expert Strategies for Managing Adverse Events With Combination Immune Checkpoint Inhibitor/Targeted Therapy

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: May 25, 2023

Expiration: May 24, 2024

CME/CE Information

Activity

Progress
1
Course Completed

Introduction

In this module developed for the multidisciplinary care team, Eric Jonasch, MD, a genitourinary oncologist, and Kathleen Moore, MD, a gynecologic oncologist, review current guidelines and best practices in identifying and managing key adverse events (AEs) related to immune checkpoint inhibitor (ICI)–based therapy, both as monotherapy and in approved and investigational combinations with VEGF-targeted agents or PARP inhibitors (PARPi).

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

If you are a practicing healthcare professional (HCP), how many patients receiving ICIs do you provide care for in a typical month?

A 65-year-old woman is receiving pembrolizumab/axitinib for her metastatic renal cell carcinoma (RCC). She develops diarrhea, and her stool frequency increases from a baseline of 2-3 per day to 5-6 per day. She is experiencing some mild abdominal cramping, but her appetite remains good.

Which of the following strategies is recommended to help determine whether this patient’s low-grade diarrhea is caused by pembrolizumab or axitinib?

The patient reports that her low-grade diarrhea has resolved 3 days after holding axitinib. She is 65 years of age and has been receiving pembrolizumab/axitinib for her metastatic RCC. Which of the following therapy adjustments should be considered?

You are counseling a patient planning to start first-line therapy with pembrolizumab/lenvatinib for advanced RCC. All of the following are recommended strategies for managing toxicities that should be discussed with the patient and their caregiver EXCEPT:

A 67-year-old woman with stage IIIC serous ovarian cancer is enrolled on a clinical trial. She received first-line treatment with chemotherapy (paclitaxel and carboplatin) plus durvalumab and bevacizumab for 8 cycles, with a partial response as her best response. She is now receiving maintenance therapy with olaparib plus durvalumab plus bevacizumab.


Since cycle 3 of her maintenance therapy, she occasionally has reported bouts of diarrhea (approximately 3 stools per day over baseline), which has been managed with over-the-counter loperamide, hydration, and close monitoring. In cycle 7, she calls and reports that her diarrhea has returned with 7 bowel movements per day over baseline, cramping, and an inability to work or even leave the house.


She presents to clinic and is hypotensive, clearly dehydrated, and in a lot of pain with cramping. She is admitted and starts high-dose methylprednisolone. A gastrointestinal (GI) consult for colonoscopy and a CT show pancolitis. Her workup is negative for Clostridium difficile and other pathogens. After 48 hours, she has not improved.

In addition to discontinuing the ICI, which of the following is recommended for managing this patient’s steroid-refractory high-grade colitis?

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