Key insights for smaller, resource-limited environments

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

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

According to Hadfield, a study from Mass General Hospital found that even experienced oncologists and subspecialists were sometimes uncomfortable dealing with these toxicities. It is therefore critical for smaller centers to seek specialized advice and take a multidisciplinary approach to effectively manage and treat patients experiencing these complex adverse events.

Transcription:

0:09 | I think the most important thing to think about with regard to immunotherapy toxicities, particularly if you’re in a smaller, resource-limited setting, would be that you have to have a high clinical suspicion. I think we’re all very vigilant about the more common toxicities, like pneumonitis, colitis, hepatitis, you know, these things are very obvious. But immunotherapy can really affect any organ system in the body. I mean, patients can develop myocarditis, they can develop neurotoxicities that can present as aseptic meningitis, and these things do happen. And if you’re in a smaller setting, I think just like in a larger setting, you really need to bring in subspecialists quickly, particularly if you’re concerned about immunotherapy toxicity.

0:55 | There was an interesting study done a few years ago at Mass General Hospital where they basically did a survey to ask who was comfortable managing immunotherapy toxicities, and this was done at one of the largest centers in the country, one of the largest in all of the immunotherapy toxicity trials. They found that a significant portion of oncologists and some subspecialists like pulmonologists, cardiologists, etc., were not comfortable managing toxicities. If these are the types of questions that we deal with at large academic centers, focused on managing these things, I think even more so at smaller centers where you may have less experience managing these toxicities, reaching out to specialists at your own center or at other centers to try to 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 specialized approach with people who have dealt with these toxicities in the past.

Edited with AI for clarity.