Improving Immunotherapy Implementation in Community Practice
JENNIE R. CREWS, MD, MMM, FACP | June 17, 2019
Immunotherapy use is booming in the oncology setting, and with it comes some challenges for community providers to address, explained Jennie R. Crews, MD, MMM, FACP, medical director, Research Integration and SCCA Network, at the Seattle Cancer Care Alliance, and executive committee member at the Association of Community Cancer Centers (ACCC).
Immunotherapy-related questions include how to educate practitioners outside of the oncology team on immune-related adverse events; access and reimbursement issues when it comes to immunotherapy combinations; and how to handle the shifting landscape of CAR T-cell therapies.
To tackle these topics and more, the ACCC created the Immuno-Oncology Institute.
As the [immunotherapy] drugs have evolved and their use has increased, I think most practices now in the country are familiar enough with [immunotherapy] that they really have been able to overcome some of the initial challenges of bringing these drugs into the routine cancer care.
Some of the things that we're facing now include how do you extend information about management of toxicities beyond the traditional cancer team to include specialists like ER physicians or pulmonologists or gastroenterologists who may also be seeing patients who are undergoing these treatments when they have side effects or toxicities? Other challenges are what do we do with the combined IO drugs? Now we're combining them with chemotherapy, we're combining them with each other, and this presents new challenges around access for patients and reimbursement for practices.
Finally, with the advent of CAR T-[cell therapy], right now CAR T is limited to a number of centers that have accreditation to provide this very complex treatment, but we suspect that there would be a time in the future when this may be a more widely used modality of care. So how do we start to prepare for that? And now, when patients are going to specialized centers for care and come back into the community, how do we co-manage those patients?