Untangling the Multidisciplinary Care Web: Streamlining Care Through an Immune-Related Adverse Events (IRAE) Tumor Board
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THERAPY IN PRACTICE
Untangling the Multidisciplinary Care Web: Streamlining Care Through an Immune‑Related Adverse Events (IRAE) Tumor Board Laura C. Kennedy1,2,3 · Kit Man Wong1,2,3 · Nikhil V. Kamat1,2,3 · Ali Raza Khaki1,2,3 · Shailender Bhatia1,2,3 · John A. Thompson1,2,3 · Petros Grivas1,2,3
© Springer Nature Switzerland AG 2020
Abstract Immune-related adverse events (IRAEs) are becoming increasingly common as the use of immune checkpoint inhibitors expands into more tumor types and treatment settings. Although the majority of IRAEs are mild and can be managed in the outpatient setting by the medical oncologist, severe IRAEs can be life threatening and often require complex care coordination among multiple providers. These providers include a variety of non-oncology specialists who have interest and expertise in managing IRAEs. Multiple systems-based solutions have been proposed in the literature, but these need to be tailored to the needs and resources of each practice setting. In this article, we highlight the challenges of IRAE care by presenting an illustrative case from our institution. We then describe the format and structure of the IRAE Tumor Board established at the University of Washington/Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center. Finally, we discuss how this tumor board attempts to address clinical issues related to complex IRAE presentations and provide IRAE education.
Key Points Severe immune-related adverse events (IRAEs) present challenges in provider awareness, patient education, and care coordination. Systems-based solutions are critical to ensuring optimal care for patients experiencing severe IRAEs. An IRAE Tumor Board has provided significant value for our institution in managing IRAEs, educating providers and trainees around IRAEs, and providing a forum for multidisciplinary IRAE discussion.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11523-020-00739-5) contains supplementary material, which is available to authorized users. * Petros Grivas [email protected] 1
Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA
2
Clinical Research Division, Fred Hutchinson Cancer Research Center, 1144 Eastlake Ave E, LG‑465, Seattle Cancer Care Alliance, Seattle, WA 98109, USA
3
Seattle Cancer Care Alliance, Seattle, WA, USA
1 Introduction Immune checkpoint inhibitors (ICIs) have become standard therapies as well as commonly used investigational agents in a variety of tumor types. ICIs hold the potential for rapid and durable responses through the inhibition of immune checkpoints, such as PD-1/PD-L1 or CTLA-4/CD80, which regulate and prevent excessive immune responses. With the success of these agents in the palliative treatment of several malignancies, there has been a movement towards developing these therapies in the curative-intent setting, which means an increasing number of patients may receive these agents as part of their treatment. However, the toxicity profile
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