ASCO 2018 Highlights: Is Your Immune System Born or Made?

The annual meeting of the American Society of Clinical Oncology (ASCO) was all about Immuno-Oncology (IO) and novel agents targeting the microenvironment. Almost every solid tumor or hematologic session included a novel agent or target. Sessions covered chimeric antigen receptor (CAR) T-cell therapy, and PD-1, PD-L1, and TGFβ inhibitory proteins, to name a few. These novel agents were often referred to as the “new standard-of-care therapy” or as the “next innovative agent” that holds promise in treating various oncology diseases.

We learned from Michael J. Overman, MD, of The University of Texas MD Anderson Cancer Center, that regardless of a patient’s family history or other baseline characteristics, that “any patient with a colon or rectal cancer should be tested for deficient [mismatch repair] MMR.” Data has shown that knowing the patient’s MMR status can be predictive in managing outcomes for the patient and their families.

We also learned that new treatment options are available that are changing the therapeutic landscape in how triple negative breast cancers (TNBC) are being treated. Patients with TNBC whose tumors overexpress PD-1 and PD-L1, may soon be able to receive IOs that target this pathway. These data presented during ASCO showed very promising results in this otherwise hard-to-treat patient population.

From the hematologic standpoint, CAR therapies remain the most frequently discussed novel agent on every presenter’s list. Therapies targeting B-cell maturation antigen (BCMA) in patients with relapsed/refractory multiple myeloma who have been heavily pretreated are resulting in very rapid and deep responses in current clinical studies. A cure has not been identified as of yet for these patients; however, researchers are suggesting that targeting the BCMA pathway earlier might prove to be more effective for a sustainable remission.

While all of these novel therapies offer promising results, much work still remains to determine the optimal IO combinations and sequencing to treat these diseases. We also must not forget the side effects that accompany these agents, such as neurological toxicities, cytokine release syndrome, hypersensitivity reactions, infections, and endocrinology disorders. The oncology nurse’s role is critical as it pertains to assessing, implementing, managing, and coordinating the care of patients receiving any of these novel agents, and a multidisciplinary approach is optimal to ensure patient compliance and adherence to the prescribed regimen.