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Can cytokines predict adverse events in patients treated with immunotherapy?

By Rachel Thomas, Meso/Lung Cancer CNS Guy’s and St Thomas NHS Trust

ESMO 2020 was a virtual affair this year due to Covid19, however there were still plenty of interesting clinical trials and studies to broaden my knowledge.   I have picked out one of my highlights to share with you all. 

Sara Colomer-Lahiguera is an experienced Postdoctoral Researcher based in Lausanne University Hospital in Switzerland. Sara presented a paper at EONs on the use of biomarkers in immunotherapy and the nursing role.  Cytokines are signalling molecules that mediate and regulate immunity, inflammation and hematopoiesis.

Immunotherapy is now a standard of care in the treatment of Non-Small Cell Lung Cancer and recently in Small Cell Lung Cancer and as nurses we are becoming more familiar with biomarkers such as PD-1 and PDL-1. However, there have only been a few studies looking at identifying predictive biomarkers in terms of immune related adverse events.

Sara’s study looked at the role of cytokines which are signalling molecules that mediate and regulate immunity, inflammation and hematopoiesis as predictive markers for adverse events in patients receiving immunotherapy. The tumour microenvironment contains immune cells and cytokines. Tumours produce cytokines and growth factors to enhance the proliferation and survival of cancer cells. IL-7 is one of the central inflammatory cytokines and has been shown to be upregulated in the blood of patients with inflammatory bowel disease. Elevated baseline IL-7 levels were found to be significantly associated with the later development of grade 3 colitis in patients on immune checkpoint inhibitors. 

Sara suggested that research into this area at present was limited, however her paper demonstrated the potential to be able to check for certain cytokine levels in patient’s tumour prior to commencing immunotherapy. In doing this clinicians may well be able to predict which patients will experience significant adverse events as a result of being treated with immune checkpoint inhibitors. It is clear more research needs to be undertaken into this theory before it makes it into clinical practice but I found this idea exciting due to the potential of being able to predict which patients may go on to experience adverse events prior to commencing immunotherapy. This would then enable both clinicians and nurses to track and monitor patients in a more targeted fashion and ideally identify and treat adverse events in a very timely manner. 

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