Dr. Borghaei on the Management of Immune-Related Side Effects in Lung Cancer

Hossein Borghaei, DO, chief, Division of Thoracic Medical Oncology, director, Lung Cancer Risk Assessment, associate professor, Department of Hematology/Oncology, Fox Chase Cancer Center, discusses the management of less common side effects that patients with lung cancer can experience when treated with immunotherapy agents.

According to Borghaei, oncologists have seen some liver-function test abnormalities when patients with lung cancer receive immunotherapy. Such abnormalities don’t tend to cause symptoms for the patient, he says, but they can be clearly identified on routine blood testing. Management of this adverse event would likely require high-dose steroids, which, says Borghaei, have generally become part of standard side effect management.

Now that immuno-oncology drugs are available to a wider patient population, oncologists are seeing side effects that they simply have not seen in limited patient populations who were treated on clinical trials. These conditions are new to several medical oncologists, and they are not particularly comparable with side effects seen with traditional cytotoxic chemotherapy.

For example, says Borghaei, there are some isolated cases of auto-immune diabetes, which is a particularly difficult condition to treat, as it requires initiation of treatment with insulin. Thus, it is vital to continue to monitor patients receiving immunotherapy very closely and to always follow up regularly with them.