Importance of AE Management With TKI/Immunotherapy Treatments

Sarah Sagorsky, MPAS, PA-C

John Hopkins Hospital

When administering treatment with agents like Tyrosine kinase inhibitors (TKIs) or immunotherapy, adverse effects (AEs) are always something to be on the lookout for. When they begin to affect how a patient is living their life, or they can no longer tolerate treatment, it may be time to look for alternative options.

When discussing how to best reduce AEs and improve quality of life, CancerNetwork^® spoke with Sarah Sagorsky, MPAS, PA-C, a senior physician’s assistant at Johns Hopkins Hospital. Sagorsky, who specializes in thoracic malignancies, reiterated the importance of communicating with patients and teaching them the tools to have an independent life while on treatment.

Of note, she mentioned the importance of multidisciplinary care, and why reporting of AEs can help determine dosing regimens in the future.

CancerNetwork^®: How do you best mitigate AEs when administering TKIs or immunotherapy?

Sagorsky: As an advanced practice provider, we see patients prior to initiating the therapy. I like to do a full review of systems and a physical exam prior to starting a TKI or immunotherapy. Typically, we do a basic baseline set of vitals, including [taking] pulse oxygen at rest and with walking, [and] I review labs and imaging. And when patients are on therapy, whether it be a TKI or immunotherapy, I think the best way to mitigate AEs is to educate patients before they even begin therapy.

I encourage patients to call when they start to develop any change from their baseline symptoms. [This includes] what they had prior to starting treatment, whether it be the TKI or immunotherapy, and to call if any new symptoms develop while they’re on therapy. I think that by informing their health care provider, we’re able to see the patient, initiate the workup, and determine a treatment plan based on the AEs they’re experiencing.

When making sure the appropriate dose is given, why is it so important to report AEs?

It’s important to educate the patients on reporting subjective symptoms they’re experiencing [that could be related to] therapy, first and foremost, as some of the symptoms don’t always correlate with objective findings that are seen on imaging and labs. In that situation, we want to determine if a patient needs a dose reduction or if holding therapy is warranted based on the AEs they are experiencing.

How do you help patients to experience a better quality of life while on treatment?

Cancer affects a patient's quality of life in many different facets. Some patients are anxious about the physical symptoms they may experience while they’re on therapy. While other patients have the emotional component of feeling anxious or depressed and not wanting to be a burden on their family while they’re undergoing therapy.

At Johns Hopkins, we as APPs help with the AEs related to the treatment that they are on, in addition to working closely with our attending physician and our clinical pharmacy specialist. We also refer patients to our palliative care physicians and advanced practice providers who can help with pain control, fatigue, and help patients live their best life while on therapy. We also want to refer patients to our clinical social workers who can help provide information on additional support groups that help with transportation to their appointments, and insurance issues while they’re undergoing therapy.

What are some unmet needs regarding immune-related AEs, and how do you hope to see them overcome in the future?

More patients are receiving immunotherapy as part of their treatment plan. There’s an opportunity for additional toxicities to occur as we continue to treat more and more patients. I think the biggest unmet need that we’re trying to figure out is how to identify patients who are going to be at a higher risk for developing toxicities and be able to identify that prior to starting therapy.

Is there anything else you would like to add?

To provide a high level of care for our complex oncology patients, [it] involves multiple specialties, and communication across all of those disease groups. It’s important to see the patients regularly and check in with them and their family members to see if there’s anything else that we can do to help them live their best life while they’re undergoing therapy