Impact of pharmacists on identification of immune checkpoint inhibitor toxicities

Abstract

AbstractBackgroundThe use of novel immune checkpoint inhibitors (CPIs) has changed the face of management for cutaneous malignancies since their introduction. While these agents are associated with exciting outcomes, they are also associated with unique toxicities, referred to as immune‐related adverse events (irAEs). Early recognition and management of these adverse reactions is important to prevent morbidity and mortality associated with these agents. At our institution, patients who receive every two‐week CPIs are eligible for enrollment into the telephone toxicity monitoring program led by the skin center clinical pharmacists. Our intention for this study is to review the departmental experience and impact to patient care with the implementation of pharmacist telephone follow‐up calls.MethodsThis is a retrospective, observational cohort study of all adult skin center clinic patients who received every two‐week dosing of nivolumab and avelumab with a documented telephone follow‐up encounter from June 1, 2015 to September 30, 2019. Patients were identified via the skin center telephone call patient database.ResultsA total of 726 follow up calls were conducted among 177 patients. There were 278 (38.3%) calls with at least one intervention. Of these interventions, 59.4% were considered clinically non‐significant and 40.6% were clinically significant which are considered irAE‐related. The most commonly identified irAEs were gastrointestinal, dermatologic, and endocrine, and most irAEs were low grade. The median time to complete a toxicity assessment for both clinically non‐significant and significant was 30 minutes.ConclusionsOur data show that a pharmacist‐driven telephone toxicity assessment program in a skin center clinic over a four‐year time span can lead to the identification of clinically significant irAEs and beneficial interventions to patients. However, this process is time consuming and will need further evaluation in order to determine pharmacist full‐time equivalents needed to carry out this program.