Pathologists and Laboratory Community Need to Recognize IO-Related Adverse Events

Immuno-oncology (IO) is increasingly used as a treatment for cancers that don’t respond to conventional chemotherapy and, occasionally, for cancers in second-line therapy, in combination with chemotherapy.

Given IO’s increasing usage in cancer treatment, pathologist Stuti G. Shroff, MBBS, PhD, anticipates healthcare professionals will see an increase in the number of immune-related adverse events (irAEs) they encounter. These events can be very mild, such as a skin rash, or more severe, such as GI issues. Some can even lead to death.

“It’s important to recognize that this is an important cause of drug-related injury, which may not necessarily be mentioned by clinicians when they send tissue samples to the medical laboratory,” said Dr. Shroff, a faculty member of the new ASCP irAE Tumor Board Simulation and Assistant Professor of Pathology, Harvard Medical School and Assistant Pathologist of Anatomic Pathology at Massachusetts General Hospital, Boston.

“If something doesn’t fit for a particular type of disease entity, it’s important to go into the patient’s chart and dig out information to make sure the patient is on immunotherapy so that he or she can be placed in the appropriate diagnostic category,” she said.

The ASCP irAE Tumor Board Simulation, funded by a grant from Bristol Myers Squibb, is designed to educate the laboratory team on the management of these sometimes toxic side effects. The 90-minute, interactive online course features a multidisciplinary team, including a pathologist, an oncologist and a radiologist, discussing patient cases on pneumonitis, colitis, hepatitis, hypophysitis, thyroiditis, and irAEs in special populations.   

Sometimes, irAEs can present in patients long after their cancer therapy is completed and they have returned to their primary care setting, according to Dr. Shroff.  That is why it is especially important for community pathologists and laboratory professionals to recognize irAEs in patients and to effectively communicate these findings with the cancer care team.

The multidisciplinary faculty team also addresses the importance of early detection and management of irAEs to assess response to IO treatment. Throughout the module, recommendations from the 2018 ASCO/NCCN guidelines on the management of irAEs in response to immune checkpoint inhibitor therapy are reinforced.

“This module builds upon prior education developed by ASCP on irAEs, adding a rich set of patient cases as well as valuable insights from members of the multidisciplinary cancer care team,” Dr. Shroff said.

Since 2018, ASCP’s IO Work Group has overseen the design and production of IO education materials in a variety of ways, through online courses, webcasts, live meetings, quality improvement projects and more. The collective expertise of the work group members, combined with the education developed by ASCP as a part of its IO strategy, ensures that ASCP members stay ahead of the curve in this rapidly evolving landscape. 

Stay up to date on IO through ASCP’s educational activities by clicking here.