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Thematic 17: Systemic immunotherapy in urological cancers

There was no slowing down on the fourth day of the 33rd Annual EAU Congress, as two Plenary Sessions were followed by no fewer than ten different thematic sessions. At Thematic Session 17, an expert faculty presented different factors related to systemic immunotherapy, followed by a panel case discussion that was presented by Mrs. Karla Lingard (GB), registered nurse.

As the session’s chair, Prof. De Santis (GB) pointed out that, with two men and four women, Thematic Session 17 was an unusually balanced one when compared to the rest of the congress. Not only was the session multidisciplinary, featuring oncologists as well as urologists, but also multi-professional, with the participation of Mrs. Lingard.

Evaluating systemic immunotherapy
Dr. Loriot (FR) spoke about the ways in which oncologists could properly evaluate the benefits of systemic immunotherapy. He reminded the audience that systemic immunotherapy resulted in “unique patterns of response and progression that differ from those of chemotherapy or molecular targeted agents in metastatic session.”

Loriot also impressed on the audience that “treatment beyond progression should be considered due to potential pseudo-progression. There are now some immune-response criteria on imaging that we have to follow at least in clinical trial.”

Loriot concluded that upcoming new tools may be helpful in the case of circulating tumour cells, with DNA being the most promising.

Joint care
Dr. Susan Foller (DE) used several cases to illustrate the diversity of specialists that can be involved in patient treatment, particularly when dealing with the side effects of systemic immunotherapy. “Joint care means close cooperation between not only different specialists but also the patient and his or her relatives,” Foller explained.

“We need joint care to diagnose and treat immune-related adverse events more quickly and precisely, and to better deal with next steps. We achieve this by building tight networks (like tumour boards) and informing each other regularly.”

With just a few examples from practice, Foller illustrated how many different disciplines can become involved with a single patient when dealing with side-effects like rashes and pneumonitis. The joint care in this case extended to a radiologist, an infectologist to manage steroid side effects, and also a psychologist to deal with the depression that the patient suffered after treatment.

Other specialists that could become involved in the ‘joint care’ of side-effects of immunotherapy are hypophysis specialists, endrocinologists, and gastroenterologists.

Managing side-effects
Thematic Session 17 concluded with a panel discussion, where various cases were put to the assembled panel on a step-by-step basis by RN Lingard. She used the case debate to illustrate her own philosophy on the management of immuno-related side effects:

“After being treated with immunotherapy, patients can be at risk of not one but multiple auto-immune side effects. It is very important to observe the patient closely during treatment and the weaning off of steroids. Patients should be counselled of these risks so that they remain vigilant during their treatment.”

“Patients should also be encouraged to phone in with all concerns of side-effects, and if possible be seen at the treating site as soon as possible. This allows the patient to be reviewed by the same medical team that is administering the treatment.”

“A multidisciplinary approach should be considered for all types of auto-immune side effects, especially with patients with multiple side effects.”

By Loek Keizer