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When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?

How do you distinguish whether toxicity is related to the immunotherapy vs the radiation vs both? Are you seeing higher rates of these due to the combination and has it impeded the delivery of radiation?
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Has colitis and/or cystitis, and the ability to distinguish between toxicity from IO v radiation, affected your ability to utilize the KEYNOTE A-18 protocol?

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3 Answers
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Radiation Oncology · Vanderbilt-Ingram Cancer Center
Answered on

I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity.

The main thin...

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Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on

There are overall increased grade 3 toxicities by about 8-10% with the addition of pembro with any immune-related colitis being a small part of it (2-3%). However, the overall treatment time for radiotherapy in the pembrolizumab and placebo arms was 52 days with 85% completing within 56 days.

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Medical Oncology · Dana-Farber Cancer Institute
Answered on

A great question. We often consult the GI and GU disciplines. Patients are hydrated and electrolyte management is done. Patients are referred to GI and urology. If we feel the GI toxicity is related to pembro then we hold it and start steroids. It can be difficult to tell at times.

I personally hav...

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