NSCLC: Optimizing Management of Adverse Events Seen on EMPOWER-Lung3
Jason Porter, MD, shares a brief review of the toxicity profile noted on EMPOWER-Lung3 and provides practical advice on how to monitor for and manage adverse events.
Transcript:
Jason Porter, MD: When using immune checkpoint inhibitors like cemiplimab plus chemotherapy, as was used in the EMPOWER-Lung 3 trial, we have a safety profile that’s similar to what we’ve seen in other immune checkpoint inhibitor trials. There were no new safety signals. So the typical adverse events such as pruritus or skin manifestations, maybe even rash, also fatigue, anorexia, and cytopenia, particularly because of the chemotherapy component of the trial. We know that all these adverse events are possible. That is not to exclude all the itis’s, which we typically refer to when we are treating patients with immune checkpoint inhibitors, such as hepatitis, thyroiditis, colitis, and pneumonitis; all of these were adverse events seen in a clinical trial. Usually, we are monitoring for these from baseline. The patient’s respiratory status and their oxygen saturation are very important, particularly for these patients with non–small cell lung cancers [NSCLCs], many of whom may have COPD [chronic obstructive pulmonary disease] and chronic hypoxic respiratory failure anyway. Monitoring liver functions at baseline is indicated. Also, I monitor my patient’s cardiac enzymes and their BMP [basic metabolic panel] because we know cardiac manifestations of immune checkpoint inhibitor adverse events can happen, as well, including myocarditis and pericarditis with pericardial effusions.
Monitoring the thyroid function is usually included in our treatment protocols so that we see if a patient’s thyroid become dysfunctional, we can start them on therapy as indicated. Patients are already going to have fatigue—it’s a side effect of the therapy—but when the thyroid gland or the adrenal glands fail, the fatigue can be magnified. So monitoring very closely for these adverse events so that we can intervene when necessary is very important. When we do find that patients are suffering from these adverse events, using steroids is usually a last resort, but if the patient is in clinical jeopardy or in trouble with their adverse events, starting steroids is the way to go. Usually, if I see a bump in the LFTs [liver function tests] or changes that make me concerned about ensuing immune-mediated side effects, I hold therapy, and I start steroids only if grade 3 or 4. If the patient’s adverse event resolves to grade 1 or lower, I usually go ahead and rechallenge the patient with therapy. If it’s a very severe adverse reaction, obviously you don’t want to rechallenge the patient because then it may not be a candidate for the next line of therapy because of adverse events from your treatment.
Transcript edited for clarity.
