Managing Immunotherapy Toxicities: Key Insights for Smaller and Resource-Limited Settings

Matthew Hadfield, DO, a third-year hematology/oncology fellow at Brown University, discusses what community oncologists should know about immunotherapy toxicities.

Immunotherapy toxicities can affect any organ system and may present with symptoms like myocarditis or neurotoxicities. In smaller, resource-limited settings, high clinical suspicion and quick consultation with subspecialists are critical.

According to Hadfield, a study from Mass General Hospital revealed that even experienced oncologists and subspecialists were sometimes uncomfortable managing these toxicities. As a result, it is key for smaller centers to seek expert guidance and adopt a multidisciplinary approach to effectively manage and treat patients experiencing these complex adverse effects.

Transcription :

0:09 | I think the biggest thing to think about with immunotherapy toxicities, particularly if you are in a smaller resource limited setting, would be that you have to have a high clinical suspicion. I think we are all very tuned into the more common toxicities like pneumonitis, or colitis, hepatitis, you know, these things are very evident. But, immunotherapy can really impact any organ system in the body. I mean, patients can develop myocarditis, they can develop neuro toxicities that can present like aseptic meningitis, and these things happen. And if you are in a smaller setting, I think just as in a larger setting, you really need to incorporate sub specialists quickly, particularly if you are concerned that there is an immunotherapy toxicity.

0:55 | So there was an interesting study that was done at [Mass General Hospital] a few years ago [where] they basically did a survey asking who felt comfortable managing immunotherapy toxicities, and this was at 1 of the largest centers in the country, 1 at the forefront of all the immunotherapy toxicity trials. They found that a significant portion of both oncologists and some sub specialists like pulmonologists, cardiologists, etc., did not feel comfortable managing the toxicities. If these are the types of questions that we are grappling with at large academic centers, focused on managing these things, I think even more so at smaller centers where you maybe have less experience managing these toxicities, reaching out to specialists at your own center or other centers to try and get some guidance on how to manage and salvage these patients is really critical. I mean, they can be very nuanced and complex, and it really requires a multidisciplinary approach. And it requires a specialty approach with people who have dealt with these toxicities in the past.

Edited with AI for clarity