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What is a “Cancer Survivor”, and Should I Use Acetaminophen with My Immuno-oncology Agent?

Dr. Shayma Kazmi, from Penn Medicine-Abramson Cancer Center, breaks down three hot topics during the 2022 ASCO Direct Philadelphia Conference.

Dr Shayma Kazmi from Penn Medicine-Abramson Cancer Center recently reviewed updates from ASCO 2022 on the topic of cancer survivorship. She noted that the definition of a “cancer survivor” varies, but generally, any person diagnosed with cancer, from the time of their diagnosis until their death, is considered as a survivor. Beyond this, however, the definition can include not just the curable patients who have finished their primary treatment, but also those who are dying with an untreatable cancer (for example, Stage IV cancer patients in remission who may be on long-term immunotherapy). When thinking about survivorship, Kazmi explained that some survivor definitions also extend to family, friends, and voluntary caregivers of the patient, all of whom may be impacted by the cancer diagnosis. Dr Kazmi also highlighted the importance of addressing the needs of this growing population, as the number of cancer survivors has been steadily increasing. Indeed, the projected number of cancer survivors is expected to reach nearly 20 million in the United States alone, a testament to ongoing research and development of new and effective drug therapies.

On the topic of long-term cancer survivorship, Dr Kazmi also reviewed results from a study from ASCO 2022 looking at the impact of acetaminophen (Tylenol) on the efficacy of immune checkpoint inhibitor drugs, or “immuno-oncology” (IO) drugs. IO drugs are often used in cancer patients, either alone or in combination, as a way of stimulating the patient’s immune response to fight the tumor cells, and patients can be on these drugs for an extended period. In addition to concerns raised during the Covid 19 pandemic on the use of acetaminophen and other non-steroidal anti-inflammatory drugs like ibuprofen with Covid vaccines, there was evidence from previous studies which suggested that acetaminophen use could dampen the overall immune response and antibody production in response to chicken pox and other vaccinations. In one study of patients with advanced renal cell cancer that were receiving an IO called nivolumab, the investigators looked at levels of acetaminophen in the blood to determine whether patients were regularly using acetaminophen or not. They found that patients who had detectable acetaminophen levels in their blood had significantly worse overall survival compared to those who did not, suggesting that the cancer therapy was not as effective in patients taking acetaminophen. There were similar findings from two other studies of IO use in advanced cancers, which showed a trend toward worse overall survival, and poorer progression-free survival, for patients who were taking acetaminophen with their IO therapy, versus those who did not. Despite the compelling results of this study, however, Dr Kazmi stressed that more research is needed, and there is not necessarily a causative effect of the acetaminophen use in reducing the anti-cancer efficacy of IO agents. For example, it may have been that those patients who were taking acetaminophen were taking it because of cancer pain, which could indicate that their cancer was progressing, leading to their poorer survival. As such, Dr Kazmi emphasized that she does not, at present, discourage her patients from taking any acetaminophen at all, but perhaps only to avoid taking it on a regular basis, when taking an IO agent for their cancer.

See more from the 2022 ASCO Direct Philadelphia Conference here.

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