What determines eligibility for immunotherapy (immune therapy)?

Eligibility Criteria for Immunotherapy

Patients are eligible for immunotherapy if they have demonstrable evidence of specific IgE antibodies to clinically relevant allergens (for allergen immunotherapy) or if they lack active autoimmune conditions requiring immunosuppression and do not need corticosteroids for other medical conditions (for cancer immunotherapy). 1

Cancer Immunotherapy Eligibility

Cancer immunotherapy eligibility is primarily determined by the absence of contraindications rather than specific positive criteria. The Society for Immunotherapy of Cancer provides clear guidance on who is considered a candidate:

Key Eligibility Factors:

1. Absence of autoimmune conditions:

   • Patients without active autoimmune conditions requiring immunosuppressive therapy
   • Patients without history of potentially life-threatening autoimmune conditions 1

2. No need for systemic corticosteroids:

   • Patients who don't require corticosteroids to treat other conditions (e.g., brain metastases, spinal cord compression, lymphangitic spread of tumor) 1

3. Disease-specific considerations:

   • For renal cell carcinoma: Every patient should receive an anti-PD-1-based therapy as initial treatment unless contraindicated 1
   • Particularly beneficial for patients with sarcomatoid histology, papillary and unclassified RCC 1

Special Populations:

HIV-Positive Patients:

• HIV-infected individuals with cancer types that are candidates for immunotherapy should be considered for treatment 1
• Requirements:
  • Undetectable plasma viral load (pVL)
  • Continuation of combination antiretroviral therapy (cART)
  • CD4+ T cell counts preferably above 200 cells/mm³ 1

Allergen Immunotherapy Eligibility

Allergen immunotherapy eligibility is determined by different criteria focused on allergic conditions:

Key Eligibility Factors:

1. Demonstrable specific IgE antibodies:

   • Patients must have evidence of specific IgE antibodies to clinically relevant allergens 1
   • Confirmed through skin testing (primary diagnostic tool) or appropriately interpreted in vitro tests 1

2. Clinical correlation:

   • Symptoms must correlate with exposure to allergens
   • Symptoms during periods of increased exposure to allergens, with positive skin/in vitro test results 1

3. Patient factors to consider:

   • Patient's preference/acceptability
   • Medication requirements
   • Response to avoidance measures
   • Adverse effects of medications
   • Coexisting allergic conditions 1

4. Patient cooperation:

   • Patients must be cooperative and compliant
   • Able to communicate clearly with the physician
   • Mentally and physically capable of reporting symptoms 1

Contraindications and Cautions

Cancer Immunotherapy:

• Active autoimmune conditions requiring immunosuppression
• History of potentially life-threatening autoimmune conditions
• Need for systemic corticosteroids for other conditions 1

Allergen Immunotherapy:

• Non-IgE-mediated symptoms (not appropriate for immunotherapy)
• History of noncompliance
• Inability to communicate clearly with physician 1

Common Pitfalls to Avoid

1. Failing to assess autoimmune status: Always screen for active or historical autoimmune conditions before starting cancer immunotherapy 1

2. Overlooking corticosteroid use: Patients requiring systemic corticosteroids for other conditions may not be good candidates for cancer immunotherapy 1

3. Inadequate IgE confirmation: Ensure proper testing for specific IgE antibodies before initiating allergen immunotherapy 1

4. Neglecting clinical correlation: The presence of IgE antibodies alone is insufficient; symptoms must correlate with allergen exposure 1

5. Starting immunotherapy in HIV patients without viral control: HIV patients should have undetectable viral loads before starting immunotherapy 1

By carefully evaluating these eligibility criteria, clinicians can identify appropriate candidates for immunotherapy and maximize treatment outcomes while minimizing risks.