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PD-1/PD-L1 Inhibitors for Non-Small Cell Lung Cancer: Incorporating Care Step Pathways for Effective Side-Effect
1Yale University, New Haven, Connecticut.
Abstract:
Programmed cell death protein 1 receptor and programmed cell death ligand 1 (PD-L1) inhibitors are immune checkpoint inhibitors (ICIs) that provide a survival benefit for select patients with advanced non-small cell lung cancer (NSCLC). Nivolumab, pembrolizumab, and atezolizumab are second-line therapies for advanced NSCLC after chemotherapy failure. Pembrolizumab and atezolizumab are also approved as first-line treatment for advanced NSCLC, and durvalumab is a PD-L1 inhibitor indicated as consolidation therapy in individuals with locally advanced NSCLC. The novel mechanism of action of these agents provides clear efficacy benefits to many NSCLC patients without good alternatives, but it may also result in unique immune-related adverse events that many health-care providers are unfamiliar with or uncertain about how to diagnosis and manage. Highlighting the resources of the Immuno-Oncology Essentials Initiative, particularly the Care Step Pathways (CSPs), this article addresses the role of the advanced practice provider in administration, side-effect identification and management, and education of patients with advanced NSCLC receiving ICI therapy. The diagnosis and management of pneumonitis, hypophysitis, diabetes mellitus, and arthralgias/myalgias are examined in detail, addressing special considerations in the NSCLC population.
Insights
Immune checkpoint inhibitors (ICIs) like PD-1/PD-L1 blockers improve survival in advanced non-small cell lung cancer (NSCLC). Advanced practice providers play a key role in managing unique ICI side effects in NSCLC patients.
Area of Science:
- Oncology
- Immunology
- Pharmacology
Background:
- Immune checkpoint inhibitors (ICIs), targeting the programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1, offer survival benefits for advanced non-small cell lung cancer (NSCLC).
- Nivolumab, pembrolizumab, atezolizumab, and durvalumab represent key ICIs used in various lines of therapy for NSCLC, including first-line, second-line after chemotherapy, and consolidation therapy.
- While effective, ICIs present unique immune-related adverse events (irAEs) that necessitate specialized knowledge for diagnosis and management.
Purpose of the Study:
- To highlight the role of advanced practice providers (APPs) in the administration, side-effect identification, and management of ICI therapy in advanced NSCLC.
- To provide guidance on managing specific irAEs, including pneumonitis, hypophysitis, diabetes mellitus, and arthralgias/myalgias, within the NSCLC patient population.
- To emphasize the utility of resources like the Immuno-Oncology Essentials Initiative's Care Step Pathways (CSPs) for healthcare providers.
Main Methods:
- Review of current literature and clinical guidelines on ICI therapy in NSCLC.
- Focus on the practical application of management strategies for common irAEs by APPs.
- Integration of educational resources and pathways for APP support.
Main Results:
- APPs are crucial in optimizing ICI administration and patient education for advanced NSCLC.
- Effective identification and management protocols for irAEs such as pneumonitis, hypophysitis, diabetes mellitus, and arthralgias/myalgias are essential.
- Utilizing resources like CSPs can enhance APP confidence and competence in managing ICI-related toxicities.
Conclusions:
- Advanced practice providers are integral to the multidisciplinary care of advanced NSCLC patients receiving ICI therapy.
- Proactive management of irAEs is critical for maintaining treatment efficacy and improving patient outcomes.
- Educational initiatives and standardized pathways are vital for equipping APPs to handle the complexities of ICI-induced adverse events.
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