Pharmacists may help identify predictable ICI toxicities to improve cancer therapy

A recent study has shown the necessary assistance pharmacists could provide in identifying predictable toxicities of immune checkpoint inhibitors (ICIs) that are related to gastrointestinal, endocrine, and dermatological toxicities, and fatigue.

“The introduction of ICIs is changing cancer therapy, with new drugs and new toxicities—an evolving area encountered by pharmacists,” the authors said.

This study sought to compare the pattern of nivolumab-induced adverse events (AEs) observed in practice with that in clinical trial and literature data, as well as identify the presentation and treatment modalities initiated in practice.

The authors carried out a retrospective case note review across two South Australian hospitals to identify the common toxicities and symptomatic treatments experienced by patients initiating nivolumab. Then, they compared results with clinical trial data from product innovator Bristol-Myer Squib and other published literature.

Seventy patients were enrolled in the study, of which 60 (86 percent) had any grade AEs. Fifty-nine of 70 (84 percent) patients experienced mild to moderate grade 1 to grade 2 AEs and 10 (14 percent) had severe grade 3 to grade 4 AEs. These findings were consistent with those found in clinical trial and published literature data.

Collectively, the prevalence of AEs with details on presentation and treatments indicated potential pharmacy practice strategies and areas for intervention.

“ICIs are an emerging treatment in cancer therapy for prolonging life, minimizing symptoms, and selectively targeting cancer,” the authors said. “Program death 1 inhibitors, such as nivolumab, fall within this class, enabling the patient’s immune system to detect and destroy cancer.”