{
  "abstract": "Background Immune checkpoint inhibitors have transformed cancer care, offering durable responses across a growing range of malignancies, but can lead to immunotherapy-related toxicities (IR-tox) which can be complex, challenging to diagnose, and potentially life-threatening in 25-50% of patients. 1–3 Management of high-grade IR-tox often requires multidisciplinary coordination, subspecialty expertise, and advanced diagnostics and therapeutics4–6 which are typically concentrated at academic tertiary care centers; however approximately 80% of patients with cancer receive their treatment in a community settings, creating a critical gap in access to expert toxicity management. This discrepancy has led to national calls for integration of these resources into community settings.7 There is also emerging evidence that patients residing in resource-limited environments have worse immunotherapy-related outcomes.8 Despite the high prevalence and complexity of IR-tox, there has been little investigation into how these conditions are managed in the community, including the barriers and facilitators of management. Through a novel specialized IR-tox clinic, we aim to 1) explore the feasibility and early uptake of an academic-community consultation model to expand access to care, and 2) identify key factors impacting community management of these conditions through an implementation sciences framework.Methods In July 2024, we successfully launched the first dedicated IR-tox clinic providing subspecialist-led care and consultation to community sites in the US. We targeted outreach to community oncology providers at local practices and through state-wide society networks. We implemented a pre- and post-consultation provider survey to assess determinants of community-based management of IR-tox, including patient, provider, and health system level barriers and facilitators to care delivery, modeled after an implementation sciences framework.Results Establishing an academic-community referral pathway has proven feasible, with sustained consultation requests from local oncology practices. Common reasons for referral include diagnostic uncertainty, complex multisystem IR-tox, and escalation of immunosuppression. Survey data collection is ongoing and will inform targeted strategies to address gaps in care delivery. Survey data (preliminary analysis ongoing) indicate consistent barriers: 1) limited access to subspecialty input, 2) delays in diagnosis and treatment due to fragmented infrastructure, and 3) low provider confidence beyond guideline-based IR-tox management.Conclusions This study demonstrates the feasibility and early success of academic-community collaboration in managing IR-tox. To our knowledge, this is the first specialized IR-tox program in the US to extend subspecialized care to community practices. This model offers a novel opportunity to explore multilevel implementation barriers and facilitate equitable access to expert, guideline-concordant care for patients receiving ICIs, regardless of practice setting.Acknowledgements This work was made possible in part through the support of the Maryland Cigarette Restitution Fund Research Grant to the Johns Hopkins Medical Institutions (FY25)References Gettinger S, Horn L, Jackman D, et al. Five-year follow-up of nivolumab in previously treated advanced non-small-cell lung cancer: results from the CA209-003 study. J Clin Oncol. Jun 10 2018;36(17):1675–1684. doi:10.1200/jco.2017.77.0412Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. Jul 2 2015;373(1):23–34. doi:10.1056/NEJMoa1504030Boutros C, Tarhini A, Routier E, et al. Safety profiles of anti-CTLA-4 and anti-PD-1 antibodies alone and in combination. Nat Rev Clin Oncol. Aug 2016;13(8):473–86. doi:10.1038/nrclinonc.2016.58Brahmer JR, Abu-Sbeih H, Ascierto PA, et al. Society for immunotherapy of cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. Jun 2021;9(6)doi:10.1136/jitc-2021-002435Thompson JA, Schneider BJ, Brahmer J, et al. NCCN guidelines® insights: management of immunotherapy-related toxicities, Version 2.2024. J Natl Compr Canc Netw. Nov 2024;22(9):582–592. doi:10.6004/jnccn.2024.0057Schneider BJ, Naidoo J, Santomasso BD, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. Journal of Clinical Oncology. 2021;39(36):4073–4126. doi:10.1200/jco.21.01440Brazel D, Kazakova V, Fay M, et al. Connecting the dots: practical strategies for academic and community oncology synergy to advance multidisciplinary management in immunotherapy toxicity care. American Society of Clinical Oncology Educational Book. 2025;45(3):e473080. doi:10.1200/edbk-25-473080Feinaj A, Rhinehart D, Zahurak M, et al. The impact of the area deprivation index on immunotherapy outcomes in metastatic renal cell carcinoma (mRCC). Journal of Clinical Oncology. 2025;43(5_suppl):445-445. doi:10.1200/JCO.2025.43.5_suppl.445Ethics Approval This study was approved by the Johns Hopkins IRB ID: IRB00144013.",
  "authors": [
    {
      "affiliations": [
        "Johns Hopkins University, Baltimore, MD, USA"
      ],
      "name": "Dena P Rhinehart"
    },
    {
      "affiliations": [
        "Johns Hopkins University, Baltimore, MD, USA"
      ],
      "name": "Shuait Nair"
    },
    {
      "affiliations": [
        "Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD, USA"
      ],
      "name": "Mark Yarchoan"
    },
    {
      "affiliations": [
        "Johns Hopkins University, Baltimore, MD, USA"
      ],
      "name": "Laura Cappelli"
    },
    {
      "affiliations": [
        "Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD, USA"
      ],
      "name": "Julie R Brahmer"
    },
    {
      "affiliations": [
        "Johns Hopkins University, Baltimore, MD, USA"
      ],
      "name": "Aliyah Pabani"
    }
  ],
  "title": "1065 The role of a tertiary immunotherapy clinic in facilitating immunotherapy related toxicity management in the community",
  "uid": "b0658655-75de-5e53-8053-9f0400cf2a0b"
}