By. Katy Tsai, MD
Date: 11/21/2023
Katy Tsai, MD, discusses the progress in cancer survivorship on a national scale, citing data from the American Cancer Society projecting a significant increase in the number of cancer survivors in the United States over the next decade. Katy Tsai, specializing in treating advanced melanoma skin cancer patients, reflects on advancements in melanoma survivorship with the introduction of immune checkpoint inhibitors.
In her dialogue, Katy Tsai delves into the historical context, emphasizing the shift from dire prognoses for metastatic melanoma patients to outcomes with contemporary treatments. She specifically mentions the success of combination immune checkpoint inhibitor blockade, such as the combination of ipilimumab plus nivolumab, showcasing substantial survival rates beyond the once-dreaded one-year mark.
During the interview, the conversation transitions to Katy Tsai’s expertise in immune-related adverse events (IRAEs) associated with immune checkpoint inhibitors. She articulates challenges in predicting the frequency and onset of these events, especially with varying severity between anti CTLA4 and anti-PD-1/L1 agents. Katy Tsai discusses ongoing research aimed at refining management strategies, emphasizing the need for a better understanding of the underlying reasons behind IRAEs.
The interviewer prompts Katy Tsai to elaborate on the general management guidelines, specifically focusing on the Common Terminology Criteria for Adverse Events (CTCAE). Katy Tsai acknowledges the utility of standardized codification in discussing IRAEs’ severity but highlights the dynamic nature of severity grading, particularly in refractory cases or instances of persistent toxicity. She underscores the importance of early intervention and adaptability in response to patients’ evolving conditions.
The interview further explores the balance between managing IRAEs with glucocorticoids and ensuring optimal cancer treatment efficacy. Katy Tsai addresses the complexities of this issue, citing conflicting data on the impact of high-dose steroid use on overall survival. She emphasizes the need for nuanced approaches, considering the potential blunting of anti-tumor efficacy with glucocorticoid use.
In the final segment, the interviewer delves into the prognostication of chronic IRAEs, their recognition, and long-term implications for patients undergoing immunotherapy. Katy Tsai acknowledges the early stages of exploration in this area, citing a notable paper from Vanderbilt University as a step in standardizing definitions and increasing awareness of chronic IRAEs. She expresses optimism about collaborative efforts to gather data across different cancer types and contexts of immunotherapy use, contributing to a more comprehensive understanding of these prolonged adverse events.