Evaluation of a Multidisciplinary Immunotherapy Toxicity Monitoring Program for Patients Receiving Ipilimumab for Metastatic Melanoma.

PURPOSE: Ipilimumab is an effective treatment for melanoma; however, toxicity rates remain high. The objective of this study was to describe the rates of adverse events (AEs), emergency room (ER) visits, hospitalizations, and nursing resource utilization for patients enrolled in a nurse-led telephone toxicity monitoring program. METHODS: Patients received weekly telephone calls from nursing to review a toxicity checklist during ipilimumab treatment and for 8 weeks after completion. To evaluate this program, a single-center retrospective review was performed for patients treated between July 2012 and September 2017 with single agent ipilimumab for advanced melanoma. Data were collected up to 3 months post-ipilimumab. RESULTS: A total of 67 patients were included, with a mean (standard deviation) age of 61 (14.6) years. Thirty-three (49%) patients received four doses of ipilimumab, and 17 (25%) had one dose delay. The median (IQR) of any AEs reported per patient was 11 (8-17). There were 44 (66%) patients with AEs deemed to be definitely or probably related to ipilimumab, and of those, 3 (4%) experienced a grade 3 AE, whereas 4 (6%) experienced grade 4 AEs. Twenty patients (30%) had ER visits, and 31 (46%) were hospitalized during follow-up (9% ER visits and 6% hospitalizations were related to drug toxicity). CONCLUSION: Ipilimumab is associated with high rates of toxicity; however, a proactive nurse-led monitoring program was feasible and patients had low rates of grade 3-4 toxicity. Hospitalization rates and ER visits remained high; however, the minority of those were related to drug toxicity.