Multidisciplinary Approach for AE Management After Pembrolizumab/ICI

Caring for patients who experience adverse effects (AEs) while receiving treatment with pembrolizumab (Keytruda) is often reliant on various multidisciplinary professionals, according to Omid Hamid, MD.

Hamid, chief of Translational Research and Immunotherapy and director of the Melanoma Center and Phase I Immuno-Oncology Program at The Angeles Clinic and Research Institute, an affiliate of the Cedars Sinai Medical Center, stated that even though only 0.2% of patients included in the pembrolizumab safety profile assessment he conducted died of immune-mediated disease, the simple fact that occurrence is a possibility requires awareness from every individual involved.1

As compared with 10 years ago when checkpoint inhibitors were starting to be used, pembrolizumab has been approved in around 40 indications encompassing various types of disease.2 Though that means more people need to be aware of how to address different situations, many are now aware of who they need to call or what they need to do when certain AEs arise.

He also concluded by saying that, as we’ve already seen with ipilimumab (Yervoy) in the anti–CTLA-4 experience, this process will need time to be fully addressed, but ultimately, care staff will get better at identifying and managing these AEs.

Transcript:

This is an 8937-patient cohort, and when you say something like 0.2% [of patients died from immune-mediated AEs], that’s small, but it’s still individually important. [For] these risks, [we have] the same discussion; it is the fact that [because] this is a multidisciplinary team, if you have an AE, we may have to send you into the hospital, we may have to send you to a consultant, or we may have to bring you in [for care] in between. Even though it’s rare, we do state that, now, we have a greater sensitivity for these AEs, what we’re going to do [if they arise], and how we’re going to take care of them.

Remember, this is a different discussion than we had 10 years ago. Ten years ago, immune checkpoint inhibitors were beginning to come into the [forefront]; multiple physicians in the community had never used them. Now, pembrolizumab is approved for 40 different indications in first-line and second-line refractory [disease], [disease with] high tumor mutational burden, renal [cancer], multiple skin [cancers], lung cancer, etc. In one way or another, the majority of oncological nurses, the majority of oncologists, and the majority of support staff have been exposed to this and are aware. More importantly, our consultants who exist in gastrointestinal, cardiology, rheumatology, endocrinology, and more importantly, emergency room physicians who see these patients have become aware, not of how to manage these, but that there is specific management required, who [they need] to call and what [they need] to do so we are better able to take care of patients in this way.

Remember, these trials span a huge amount of time, and multiple experiences [of this] have now come forward. Pembrolizumab is not the only anti–PD-1/PD-L1 [inhibitor] that’s approved. There are checkpoint inhibitors in other ways, whether it’s LAG3 or CTLA-4, which have made us more in tune with these toxicities. That data has been borne out; we’ve seen with the initial anti–CTLA-4 ipilimumab experience that, as time went by, we were better at identifying and managing toxicities.

Reference

1. Brahmer JR, Long GV, Hamid O, et al. Safety profile of pembrolizumab monotherapy based on an aggregate safety evaluation of 8937 patients. Eur J Cancer. 2024;199:113530. doi:10.1016/j.ejca.2024.113530
2. Selected indications for KEYTRUDA® (pembrolizumab). Keytruda. Accessed February 14, 2025. https://tinyurl.com/mtpnwhrr