Background: As immune checkpoint inhibitor (ICI) use expands, immune-related adverse events (irAE) emerge as a treatment-limiting factor.(1) Identification of reliable irAE risk predictors is a growing research area.(2,3) Clinical guidelines recommend assessing irAE risk before and during treatment.(4-6) This study explores factors oncology clinicians consider, their perceptions on irAE risk prediction value, and potential clinical practice adoption.
Methods: An electronic survey was developed with three sections: 1) current practice, 2) value of risk prediction, and 3) vignette study, which contained three clinical scenarios where respondents selected treatment strategy at baseline and with increasing irAE risk. The target audience were health professionals who prescribe or manage patients receiving ICI, including nurse specialists, nurse practitioners, medical oncology trainees and consultants. The survey was validated with 12 clinicians and distributed to members of professional cancer organisations. Data collection occurred between February-July 2023.
Results: Forty responses were included for analysis from consultants (57.5%), trainees (17.5%), nurse specialists (17.5%), and nurse practitioners (7.5%) who practise in various settings and cancer sub-groups. None of the respondents used a risk assessment system/method beyond general risk profiling. If validated, a risk prediction tool was reported to certainly (30%), likely (53%), or possibly (17%) be used in clinical practice. The most preferred value of risk prediction was to tailor patient education, inform frequency of clinic review and follow-up. Perceived barriers include cost, time for pre-treatment assessment, and unknown accuracy/specificity. The vignette study underscored potential implications of irAE risk prediction. When confronted with higher predicted irAE risk, clinicians demonstrated a propensity to adjust treatment strategies. Across all scenarios, the choice of single-agent ICI therapy was favoured over combination ICI therapy as predicted irAE risk increased.
Conclusion: Clinicians perceive potential benefits to cancer care and practice from irAE risk prediction, endorsing research into risk identification. A predicted increase in irAE risk was found to be important for ICI treatment selection.