News in brief: Tocilizumab helps manage irAEs in ICI-treated cancer patients; Specialist picked to lead new Medicare review; COVID-19 vax link to menstrual changes should be investigated


Tocilizumab helps manage irAEs in ICI-treated cancer patients

Tocilizumab could help cancer patients manage immune-related adverse events (irAEs) and prevent flares of pre-existing auto-immune disorders, according to an Australian-led study.

The study assessed tocilizumab’s efficacy in 22 advanced melanoma patients treated with immune checkpoint inhibitors between 2017 and 2021. 

It found the anti-interleukin-6 receptor monoclonal antibody helped resolve irAEs in median 6.5 days and provided clinical benefit in 21 patients, despite having a shorter time to irAE onset when used prophylactically (median 32 days versus 48), the authors wrote in the European Journal of Cancer

The drug also reduced median C-reactive protein to below baseline and irAE levels (18 mg/L versus 32 mg/L and 49.5 mg/L), they added.

“Tocilizumab was well tolerated with self-limiting and transient toxicities in 11 (50%) patients”, they wrote.

The drug was an “effective steroid-sparing treatment for both the management or irAEs, as well as prevention of flare of pre-existing auto-immune disorders”, they concluded.


Specialist picked to lead new Medicare review

Professor Anne Duggan has been announced as the chair of a new Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) that will continue the overhaul of MBS items started by the MBS Review Taskforce.

The Department of Health says the advisory committee will  “ensure the MBS continues to support high quality care, and remains flexible and contemporary. It  follows the MBS Review Taskforce, which from 2015 to 2020 reviewed more than 5,700 items on the MBS and made recommendations to the minister for health to remove or streamline inappropriate and outdated items, including some for colonoscopy.

Professor Duggan is a gastroenterologist in Newcastle, NSW and Chief Medical Officer for the Australian Commission on Safety and Quality in Health Care, where she provides expert clinical advice to the Commission in its role to improve safety and quality of health care nationally.


 COVID-19 vax link to menstrual changes should be investigated

A link between COVID-19 vaccination and menstrual changes is “plausible and should be investigated”, according to Dr Victoria Male, a reproductive specialist at Imperial College London.

In an editorial published in the British Medical Journal, Dr Male said the Medicines and Healthcare products Agency had received 30,000 reports of menstrual and unexpected bleeding post vaccination with both mRNA and adenovirus vectored COVID-19 vaccines.

This number is still considered low given the proportion of people who have received COVID-19 vaccination and the prevalence of menstrual disorders in the general population. Also, in most cases periods have returned to normal by the following cycle, and there is no evidence to suggest that vaccination adversely affects fertility.

However, while menstrual changes and unexpected bleeding are not currently classed as common side effects of COVID-19 vaccination, current data collection methods make it difficult to draw any firm conclusions, Dr Male noted. Instead, she argued that researchers should be using approaches that compare the incidence of menstrual issues across vaccinated and unvaccinated populations.

“Although reported changes to the menstrual cycle after vaccination are short lived, robust research into this possible adverse reaction remains critical to the overall success of the vaccination programme,” she said. “Vaccine hesitancy among young women is largely driven by false claims that COVID-19 vaccines could harm their chances of future pregnancy. Failing to thoroughly investigate reports of menstrual changes after vaccination is likely to fuel these fears.”

While more evidence on a potential link is gathered, clinicians should encourage anybody experiencing menstrual issues post vaccination to report them to the MHRA’s yellow card scheme, Dr Male advised. Any persistent change to periods persisting or new vaginal bleeds post menopause should be managed as per normal clinical guidelines.

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