Dr. Naidoo on Treating Immune-Related Adverse Events in NSCLC

Jarushka Naidoo, MBBCh, assistant professor of oncology, Johns Hopkins University, discusses the treatment of patients with non—small cell lung cancer who develop immune-related adverse events (irAEs).

The overall incidence of irAEs is low, says Naidoo. The incidence is about 5% or less with single-agent immunotherapy drugs and around 10% for some combinations. However, the incidence of severe irAEs with the combination of ipilimumab (Yervoy) and nivolumab (Opdivo) can be upwards of 30%.

In many cases, irAEs are effectively treated with corticosteroid medications, says Naidoo. Eighty percent or higher of patients with pneumonitis are treated effectively with steroids, so that the pneumonitis improves or resolves. However, in a small percentage of these toxicities, steroids may not be sufficient.

In patients who have colitis that does not improve after 48 hours, physicians tend to offer them a second immunosuppressive agent. For colitis, physicians give infliximab (Remicade). Depending on what the toxicities are, those second immunosuppressive agents may be different, explains Naidoo. For hepatitis, physicians give mycophenolate mofetil, but for certain toxicities, such as pneumonitis, the optimal second agent is not actually known. This is actively being studied, states Naidoo.