Navigating Immune-Related Adverse Events: Community Oncologist Practices and Perceptions in the Era of Immunotherapy

OBJECTIVES: Immune checkpoint inhibitors (ICIs) revolutionized cancer treatment by enhancing the body's immune response against malignancies, leading to improved survival rates. However, the success of ICIs is often accompanied by immune-related adverse events (irAEs). Management of irAEs is crucial to maintaining the therapeutic benefits of ICIs. Yet, quality evidence supporting appropriate irEA management is lacking. This survey explored the practices of community oncologists in handling irAEs in patients treated with ICIs.

METHODS: We conducted a cross-sectional survey using a convenience sample of community oncologists from Cardinal Health’s Oncology Provider Extended Network (OPEN). The survey was distributed to approximately 300 physicians during September 2023 and captured data on the number of patients each clinician managed, their comfort level with managing irAEs, and resources and guidelines used to inform clinical decisions regarding irAE management.

RESULTS: Of 41 respondents, 37 (90%) reported experience managing patients with irAEs. Participating oncologists managed approximately 566 patients with irAEs monthly, of which, nearly half (48%) of irAEs were grade 3 or higher. All respondents felt comfortable managing irAEs, with the majority (84%) comfortable managing all grades, though some (16%) were comfortable with only low-grade events. Most (86%) physicians reported major barriers to irAE treatment including timely access to subspecialists (65%), timely access to testing (46%), and timely access to medications such as biologics (35%). Physicians reported relying on the National Comprehensive Cancer Network (59%) or the American Society of Clinical Oncology (38%) guidelines for immunotherapy toxicity, and UpToDate (32%), peer-reviewed journals (24%), and scientific meetings (20%) for new guideline information.

CONCLUSIONS: This study highlights the critical role of community oncologists in managing irAEs. Future efforts should focus on enhancing the resources available to community oncologists and developing comprehensive guidelines to ensure the effective management of irAEs.