Gestion des toxicités induites par les inhibiteurs des points de contrôle immunitaire en oncologie : cartographie des pratiques françaises

Immune checkpoint inhibitors (ICI) are an increasing proportion of oncology therapies. The oncologist is faced with the managing immune-mediated adverse effects (irAEs), which are sometimes complex, the introduction of ICIs in patients with history of autoimmune diseases, and rechallenging after toxicity. This multidisciplinary care is still uneven. The main objective of this study is to describe the management of this irAES within the university hospitals (UH) with oncology department and comprehensive cancer centers (CCC). We built this study around a survey sent to all UH and CCC in metropolitan France, as well as to all the hospitals authorized to treat cancer in the Nord Pas de Calais region, in order to assess the resources available and the areas of improvement. Multidisciplinary tumor boards dedicated to irAEs were available in 39% of CCCs and UHs, the remaining 61% had a network of specialists. The main problem encountered is the difficulty of bringing together the various specialists. The resources available at the regional level were not well known to the practitioners, who declared that the local resources were insufficient. We have identified five areas for improvement: the generalization of therapeutic education, the strengthening of the city-hospital link, the facilitation of access to specialists who know the specificities of irAE, the sharing of information through pharmacovigilance department and the promotion of further studies.