Clinical Fellow in Oncology Cambridge University Hospitals NHS Foundation Trust, United Kingdom
Background: The utilisation of immunotherapy (IO), specifically checkpoint inhibitors, for kidney cancer and other solid tumours has increased over recent years and is associated with significantly improved outcomes, warranting sufficiently resourced healthcare systems to deliver treatment. However, IO-toxicity is common, with rates of up to 27% for anti-CTLA4 therapies, 20% for PD-1/PD-L1 therapies and 55% for combinatory therapies. Given this, clinical encounters related to IO-toxicity is suspected to have increased, requiring additional resources. Hence, the aim was to evaluate the change in clinical activity related to IO-treatment and toxicities, with a specific focus on kidney and melanoma tumours.
Methods: Retrospective analysis of IO-related clinical encounters in April 2019 and April 2022 at Cambridge University Hospitals NHS Foundation Trust.
Results: Total IO activity has increased dramatically in recent years, from 214 patients treated in 2019 to 311 in 2022, with kidney and melanoma patients accounting for 20% each. There was an increase in acute oncology service (AOS) IO-related encounters when comparing April 2019 and April 2022, with an increase of 118% for AOS telephone encounters, 170% for cancer assessment unit (CAU) encounters and 160% in the Emergency Department. In April 2022, 73% of CAU attendances were IO-toxicity related, compared to 42% in 2019.
Renal clinic IO encounters increased from 20 in April 2019 to 67 in April 2022, with the proportion of IO-toxicity encounters increasing from 7% to 14%. There was a marked increase in rates of IO-related colitis, increasing from 1 to 12 patients. Melanoma clinic IO encounters increased from 49 in April 2019 to 53 in April 2022, with a small increase in the proportion related to IO-toxicity, from 15% to 18%.
Conclusions: Utilisation of IO is increasing with a commensurate increase in rates of IO-toxicity, requiring healthcare systems to be adequately resourced to ensure the safe delivery of these clinically effective therapies.