SPOTLIGHT alarming because access to ICI therapy has been shown to improve overall survival compared to other types of treatment, such as chemotherapy (512). There are also socioeconomic disparities in the access to immunotherapies. In a recent study examining immunotherapy use among patients with advanced-stage NSCLC, researchers found that having a low income and a lower level of educational attainment were associated with lower likelihood of receiving immunotherapy, and this persisted regardless of race or ethnicity (353). There are also disparities in access to adoptive cell therapies. One study that evaluated the geographic distribution of CAR T-cell clinical trials for multiple myeloma found that 34 percent of states analyzed had no CAR T-cell or bispecific antibody clinical trial openings, with limited sites in states that have the highest percentages of Black residents (513). These data may explain why only two to five percent of participants in the pivotal clinical trials that led to the FDA approval of the CAR T-cell therapy tisagenlecleucel for ALL were Black (514). Inequities in the current utilization of these highly effective therapies mandate further research to identify current barriers to the use of immunotherapy among medically underserved patients with cancer and to develop ways to address those barriers at the earliest possible time. Common Side Effects of Immune Checkpoint Inhibitors In 2011, the U.S. Food and Drug Administration (FDA) first approved a new type of immunotherapeutic called immune checkpoint inhibitors (ICIs), which are treatments that help the body recognize and attack cancer cells. Since then, the success of these treatments has led to many more people living longer, fuller lives after a cancer diagnosis. Only now are we seeing the long- and late-term side effects that can develop in patients treated with ICIs. The incidence of immunerelated adverse events (irAEs) from ICIs depends on the drug being used and the tumor type; some of the most common irAEs are listed above (499-501). Developed from (502). FIGURE 20 GASTROINTESTINAL Celiac disease Colitis/diarrhea Esophagitis Hepatitis Pancreatic insu ciency RESPIRATORY Persistent wheezing/coughing Pneumonitis CARDIOVASCULAR Myocarditis ORAL Xerostomia RHEUMATOLOGIC Arthritis NEUROLOGIC Guillain-Barré syndrome Myasthenia gravis Neuropathy OCULAR Ocular toxicity DERMATOLOGIC Dermatitis Mucositis Pruritus Vitiligo ENDOCRINE Adrenal insu ciency Diabetes Hypophysitis Thyroiditis/hypothyroidism Immunotherapy: Pushing the Frontier of Cancer Medicine AACR Cancer Progress Report 2023 127
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