Lyudmila Bazhenova, MD, Talks About Immune-Related AEs in Lung Cancer
Dr Bazhenova talks about the management of immune-related adverse events in patients with lung cancer.
Dr. Lyudmila Bazhenova: I'm Dr. Lyudmila Bazhenova, Professor of Medicine and thoracic oncologist from University of California, San Diego.
Immunotherapy is here to stay. We know that the drugs are very effective in patients with non‑small‑cell lung cancer. We slowly moved immunotherapy from a second‑line setting to the first‑line setting.
As we know, immunotherapy can be associated with immune‑related adverse events. By now we have figured out how to manage those events correctly. There is plenty of resources including NCCN Guidelines, asthma guidelines, that will explain to practicing physician how to correctly manage immune‑related adverse events.
What we are lacking is understanding of safety of immunotherapy in certain populations, such as patients with pre‑existing autoimmune conditions, patients with HIV, patients with hepatitis B and hepatitis C. What we know that it is OK to give immunotherapy to patients with controlled autoimmune disorders. This is however based purely on retrospective data.
As long as your autoimmune disorder is controlled, you could consider giving immunotherapy to those patients. You do have to be aware that they have about 25 to 40 percent chance of exacerbation of their autoimmune disorder, which needs to be promptly recognized and treated.
When I personally make a decision, if I want to give patient result immune condition immunotherapy, the type of autoimmune condition matters. For example, my patients with myasthenia gravis, I probably would be very reluctant to give immunotherapy because if myasthenia gravis exacerbates, that can lead in severe changes in patient quality of life.
Another example would be patient with Scleroderma who has, already, pulmonary fibrosis. Then I would be very worried in causing pneumonitis on those patients. On other hand, if I have a patient for example with rheumatoid arthritis, mild symptoms controlled, those people are absolutely safe to give immunotherapy.
The second population I will be talking about is patients with HIV. We now have a first prospective study looking at the safety of immunotherapy in HIV. Overall it is safe, but we do need to be worried about exacerbation of multicentric Castleman disease that can happen in those patients.