Dr Mehta on the Mitigation of Common Immunotherapy-Related Toxicities in Urothelial Cancer

"Immunotherapies are well known in practice, across the US and the world. That helps us leverage our knowledge. We just need to educate our teams [to] make sure everybody’s up to speed about what to monitor for, how to diagnose if a problem is happening, and then treat when necessary."

Amit Mehta, MD, a physician consultant at Premier Hematology, discussed key immune-related adverse effects (irAEs) associated with immunotherapy-containing regimens for urothelial cancer and offered practical strategies for toxicity monitoring and management in routine practice.

As immunotherapy is frequently incorporated into treatment regimens—such as in the combination of enfortumab vedotin-ejfv (Padcev) with pembrolizumab (Keytruda) or with chemotherapy backbones—there is a consistent risk of irAEs across therapeutic settings, Mehta began. Common irAEs include pneumonitis, colitis, autoimmune hepatitis, hypothyroidism, and hyperthyroidism, he listed.

The critical component of effective irAE management in real-world practice is the establishment of standardized protocols for early identification, diagnosis, and intervention, Mehta stated.

For example, in cases of suspected immune-mediated pneumonitis, a structured approach must be followed, which includes clinical assessment, radiographic imaging, and prompt referral to pulmonary specialists when necessary. Similar protocol-based management strategies should be applied for other irAEs. It is vital to plan ahead and ensure all team members are aligned on workflows to recognize and address toxicities, Mehta emphasized.

He further underscored the value of team education. Although oncologists may be familiar with the AE profiles of checkpoint inhibitors, given their widespread use across tumor types, multidisciplinary awareness remains essential to ensure timely action. This includes training nursing staff, physician extenders, and support personnel to recognize early signs of irAEs and escalate care as needed, he noted.

The increasing ubiquity of immunotherapy in oncology care has led to improved clinician familiarity and comfort with irAE management, which ultimately enhances patient safety and treatment continuity, Mehta asserted. However, he noted that newer therapies or less frequently used combinations may still present a learning curve. Therefore, maintaining up-to-date knowledge and reinforcing team-based education can help optimize outcomes, Mehta concluded.