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Is Immunotherapy Contraindicated in Melanoma Patients Who Also Have Immune Disorders Like Rheumatoid Arthritis?

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Published on July 27, 2015

Andrew Schorr and Carol Preston speak with Dr. Michael Wong about the contraindication of immunotherapy administered to melanoma patients with rheumatoid arthritis. Dr. Wong explains the importance of reviewing each patient, case by case, as each person’s autoimmune disease is mechanically unique and reacts to different checkpoint inhibitors. In researching this matter, information is collected from dozens of oncologists who use immunotherapies in patients with rheumatoid arthritis. The data assembled provides patients with options to discuss with their doctors.

This in-person town meeting was sponsored by the Patient Empowerment Network through educational grants from Genentech and Novartis. It was produced in partnership with Banner MD Anderson Cancer Center, and the Melanoma Research Alliance.

 

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Transcript | Is Immunotherapy Contraindicated in Melanoma Patients Who Also Have Immune Disorders Like Rheumatoid Arthritis

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Carol Preston:

Is immunotherapy contraindicated in melanoma patients who also have immune disorders like rheumatoid arthritis?

Andrew Schorr:                  

Okay, Dr. Wong?

Dr. Wong:             

That’s an excellent question. And you know these patients have been excluded from trials specifically, I think so, right. So you don’t have rheumatoid arthritis, it goes on and on. So it’s a knowledge gap.  So on a case-by-case basis; we’re looking at these folks. And I’ll tell you what I do.  If there’s zero information, we have our own posse that we reach out to. We collect information. For instance, coming up at our major meeting this year is a presentation, which is collated across dozens of oncologists who treat with immunotherapies specifically on the question of rheumatoid arthritis, for instance.

So we recognize that’s an issue. So it’s a case by case. Not all autoimmune diseases are built the same.  And they’re not all the same mechanistically. And they react differently to the different checkpoint inhibitors, be it the CTLA4s or the PD-1s.  So the answer is that yes, it’s possible. Yes, we’ve done it.  And it’s a case-by-case basis.

This thing about the drive home was very important because, in California, I say to my patients, a new referrals, I say, “You’re going to have a long drive home, because it’s California after all. So you get on the 5 freeway. It could be hours.  And I say, listen, when you have questions,” and I give them my card, which has an email address. I say, “I’m not like my kids. I can’t do this. But write the questions down. Put a phone number down. We’ll find the time where I’m not in clinic and pressed for time where we can just spend a few minutes going over these questions because you will have them.”

“So instead of freaking out in the car, just write them down.” And usually I get like Dear Dr. Wong, numerated one to whatever, and then a phone number. And then we just find the time. And I find that’s a lot more helpful because then what happens is people come in, and you’re trying to make a treatment decision, and they’re completely freaked out about something, which you thought you had covered.  There were studies done in which people gave money. If you patients and their family could remember three points an oncologist says. So they almost gave no money out because they could not remember three points their oncologist said a week after they said it. 

They taped it, gave the tape to the patient, and believe it or not, not everybody got their $20.00 because, even after listening to the tape, it doesn’t always help you because you’re not there. And the tape is only a fraction of what you’re talking about. There are a lot of nonverbals that go along with this as well. And that’s why I don’t like these sort of over the phone things, especially not by text.

So it’s an imperfect communication circle. The only remedy, I think, is frequent communication. Ask, check, make sure you got it, check back. But then you’re freaked out because we just said the word cancer, and then we come back and check back again and again. So the antidote I feel is not just communication but frequent communication.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.