Objectives
  • To be able to perform specialist assessment, treatment and counselling of patients with cancer who will be receiving immunotherapy (for cytokines and haematopoietic growth factors, see chapter 4.3.4)

Awareness
  • Appreciation that the basic principles of tumour immunology provide the biological justification for the use of different types of immunotherapy for cancer

  • Appreciation that monoclonal antibodies such as checkpoint inhibitors, and adoptive cell therapies can be used in different malignancies

  • Appreciation that immunotherapies may have a unique spectrum of toxicity not seen with chemotherapy or targeted therapy

  • Awareness that unconventional patterns of response occur with immunotherapies including late responses or regression after progression

  • Appreciation that immunotherapy has the potential for achieving responses of long duration

Knowledge
  • Familiarity with the different arms of the immune system that comprise immunotherapy

  • Understanding how the use of antibodies differs from cellular therapy

  • Familiarity with the differences between immunotherapy and targeted therapy or chemotherapy

  • Familiarity with the signs and symptoms of immune-related adverse events and their management

  • Familiarity with cytokine release syndrome seen with adoptive cell therapy and its management

  • Familiarity with the management of unconventional responses and the need to verify progression in selected patients that may have pseudo-progression or a mixed response

  • Understanding that the duration of immunotherapies varies, with prolonged use of checkpoint inhibitors to limited use of adoptive cell therapy

Skills
  • Ability to contribute actively to a variety of immunotherapy clinical scenarios and patient presentations

  • Ability to discuss immunotherapy treatment options/recommendations critically

  • Ability to perform a history and physical examination in immunotherapy patients

  • Ability to contribute to discussions on choosing the right patient for immunotherapy, based on histology, staging, tumour burden, performance status and tolerance of toxicity

  • Ability to contribute to discussions on choosing the optimal sequence of immunotherapy with other standard therapies

  • Ability to recognise and manage the immune-related adverse events seen with checkpoint inhibition, most commonly including skin, endocrine, gastrointestinal, pulmonary and hepatic systems

  • Ability to assemble a multidisciplinary group of consultants to facilitate the care of patients suffering from immune-related adverse events

  • Ability to recognise and manage the cytokine release syndrome seen with adoptive cell therapy

  • Ability to distinguish immune-related toxicity from progression of disease

  • Ability to perform a risk–benefit assessment for patients considering adjuvant immunotherapy

  • Ability to determine the optimal duration of immunotherapy, including checkpoint inhibitors based on their toxicity profile and the likelihood of having an unconventional response