Increasing physician recognition and management of immune-mediated adverse events (imAEs): Results of a structured learning platform.

Abstract

211 Background: Immunotherapies have significantly improved cancer outcomes across multiple tumor types, while concurrently introducing new and unique toxicities, requiring timely recognition and intervention. To advance physician knowledge of imAEs, an educational online platform was developed for use by AstraZeneca clinical trial investigators (PIs). Herein, we report the impact of this educational strategy on PIs’ knowledge and confidence in recognizing and managing imAEs. Methods: The web-based learning platform included 8 structured and interactive modules (mode of action, colitis, pneumonitis, rash, hepatitis, endocrinopathy, neurotoxicity and nephritis), each containing 3 lessons reviewing background, pathophysiology and diagnosis of individual imAEs, management strategies and expert videos. Pre- and post-training questions to test knowledge (n = 5) and confidence (n = 2) were offered. The platform launched in May 2016 and remains active. PIs participating in durvalumab and/or tremelimumab clinical trials are eligible for participation. Results: As of Jan 19 2017, 2372 PIs have been invited to participate, 356 accessed the platform, and 294 completed ≥1 lesson (57% mode of action, 62% colitis, 42% pneumonitis, 20% rash, 24% hepatitis, 18% endocrinopathy, 19% neurotoxicity, 15% nephritis). Although an overall high proportion of correctly answered questions was identified at the pre-training stage (73% of 2935 total questions, n = 169 PIs), accuracy increased by a mean of 11% (range -3‒27%) at the post-training stage (84%). In each module, there was ≥1 question (range 1‒3) for which correct answers increased by ≥15% post- vs pre-training. Overall, after learning, confidence levels in recognition and management of imAEs increased by 28% (57 to 85%, p < 0.05; n = 35‒102 PIs) and 28% (51 to 79%, p < 0.05; n = 28‒101 PIs), respectively. Conclusions: The number of PIs completing ≥1 lesson indicates a desire for imAE training. This educational initiative enhanced knowledge, and among PIs with suboptimal confidence pre-training, 1 in 2 reported increased confidence in imAE recognition and management, which may improve patient care and maximize treatment potential.