Panacea or Pandora's Box? Immune Checkpoint Inhibitors and Palliative Care (TH314)

Abstract

•Identify the expanding role of immune checkpoint inhibitors (ICIs) in the management of cancer.•Utilizing patient case scenarios, summarize the positive and negative outcomes associated with ICI therapy.•Categorize the most common immune-related adverse events that may result from ICIs.•Discuss how treatment with ICIs may affect decisions in the shared care of cancer patients between medical oncology and palliative care. Over the past several years, a wave of new cancer immunotherapy agents referred to as immune checkpoint inhibitors (ICIs) have transformed the standard of care for patients with cancer. ICIs are most commonly used in advanced cancers with palliative intent and recently as frontline therapy for some cancers. These new agents have been shown to extend overall survival (OS) and progression free survival (PFS) in patients with lung cancer, melanoma, Hodgkin lymphoma, renal cell carcinoma, urothelial carcinoma, Merkel cell carcinoma, head and neck cancer, and more. ICIs activate the immune system to recognize and attack cancer cells. As a result of more precise therapy, patients are able to avoid some of the systemic side effects seen with traditional chemotherapy. Alternatively, ICIs may lead to overactivation of the immune system causing, unique autoimmune phenomena. In some instances, immune checkpoint inhibitors are being used as a therapy of last resort. Palliative care specialists should recognize uses, potential adverse effects and management, and end-of-life care challenges in patients that receive ICIs. This session will be presented by interprofessional hematology/oncology and palliative care clinicians. The role and mechanism of ICIs will be reviewed by an oncologist. We will use case examples to demonstrate positive and negative outcomes of ICI therapy. We will list immune-related adverse events and their management. Lastly, as a group we will discuss end-of-life challenges that may result from ICI therapy and how to best collaborate with oncology providers.