Understanding Immunotherapy: Hadfield's Perspective

Matthew Hadfield, DO, a third-year hematology/oncology fellow at Brown University, discusses his interest in immunotherapy and the toxicities associated with them, highlighting impactful FDA approvals and future directions.

Transcription:

0:09 | ​​Immunotherapy, the first FDA approval for ipilimumab [Yervoy] back in 2011 in melanoma, I mean, that is a disease state that prior to ipilimumab and nivolumab [Opdivo], the median overall survival at 1 year was about 25%. Most patients were deriving almost no benefit from the therapies that we were giving for the decades prior to ipilimumab and seeing the profound impact it has had on patients with melanoma and multiple solid tumors has been so fascinating. But the reality is that of patients who get 2 checkpoint inhibitors, almost half of them develop severe toxicities. While you have this potential therapy that could provide years and years of benefit, you also cause a lot of harm with the toxicities associated with these therapies.

0:57 | I think this is becoming more and more relevant as we start to take immunotherapies from the metastatic and palliative setting down into the neoadjuvant setting. At the current time, we have no predictive biomarkers for who is gonna develop a toxicity. We really do not understand the patient characteristics that predispose people to developing toxicities, and we are still really grappling as a field trying to understand how best to manage toxicities and whether or not we can rechallenge with immunotherapies in the future and what that sort of looks like. There are all these huge questions and in the backdrop of these questions, we are taking these therapies from the metastatic setting, and we are putting them into the neoadjuvant setting.

1:35 | Patients who get immunotherapies prior to potentially curative surgery, some percentage of them, are going to develop a toxicity that then takes the therapy and it takes away their chance for a cure. I think that really highlights just how critical it is for us to understand more about immunotherapies and the toxicities that patients get and how better to manage them. I think that is what has drawn me to that field is just there are lots and lots of questions. I certainly would not want to take away from the fact that immunotherapy has changed the landscape of how we treat patients and adoptive cellular therapies and CAR T in the future are going to continue to widen that landscape. But there are just a lot of questions that we do not have answers for.