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ETHOS Event Collective’s Unique Approach Delivers Return on Investment for Companies and Communities

ETHOS Event Collective's Unique Approach Delivers Return on Investment for Companies and Communities

ORLANDO, Fla., Aug. 01, 2022 (GLOBE NEWSWIRE) — A multi-billion dollar industry, meetings and events represent important revenue and jobs for communities throughout Florida. This impact was demonstrated when COVID shut down in-person activities resulting in widespread job loss and business closures. Amid this industry devastation, ETHOS Event Collective, a new destination and event management company, is taking its unique, results-oriented approach to the events industry. Through purposeful planning and precise execution, ETHOS creates engaging, memorable experiences that result in meaningful, lasting results for companies and local communities.

“The pandemic clearly showed how meetings and events generate important jobs and revenue that support the well-being of the communities where we work,” said Meryl Hill, VP, Creative + Design, ETHOS Event Collective. “It was this realization that started ETHOS and our purpose to create a sustainable way to ensure we supported the people and places that help us create experiences for our clients.”

Delivering on this purpose began by reinventing their creative process. “Planners select destinations because of their unique experiences and offerings,” said Julie Addelman, Director of Experience + Design, ETHOS Event Collective. “We developed a methodology that would build on destination experiences to create a deeper connection with the community – one that would be remembered long after the meeting or event ended.”

Inspired by the creative process used by marketing and advertising firms, ETHOS has invested in training their Experience and Design team to go beyond meeting and event objectives to align with broader company goals, mission, values, and brand to make a meaningful connection between the attendees to the destination. Recently the Orlando team helped an automotive company plan a dealer incentive that was equal parts giving and receiving. A Concours D’Elegance style gala combined the attendees’ love of classic cars with the company’s desire to support their annual giving by incorporating a silent auction to support Feeding America.

According to Hill, “Building connections is the easiest and fastest way to create a return on event investment. When content and programming are purposeful, it creates bonds with brands, locations and information. Learning opportunities can be created that feel native to your corporate culture and appropriate for your venue. Incorporate ways to create interactive memories, with follow-up that reinforces main ideas and connects the experience to the content. Offer hands-on experiences with exclusive options they couldn’t do on their own. This creates connections with people and companies, grows brand loyalty, improves employee retention and builds solid foundations.”

She adds, “A bonus by-product is that you’ll be equipping communities and destinations with the power to grow. When we partner with an organization like Feeding America, we are creating connections that help people thrive.” 

ETHOS believes this type of purposeful planning produces more meaningful connections, experiences and results that have a greater impact on things like employee retention, sales, and brand loyalty. The ETHOS creative methodology also incorporates Simon Sinek’s seminal concept of “Start with Why”. Hill attributes this idea to having a big influence on the team’s creative process. She concludes, “Getting a deeper understanding of WHY companies want to create these meetings and events enables us to create a truly unique experience that has a long-lasting impact.”

To learn more about their creative methodology and how it has already begun to make an impact in local communities, contact ETHOS VP, Creative + Design, Meryl Hill at meryl.hill@ethoseventcollective.com or Director of Experience + Design, Julie Addelman at Julie.addelman@ethoseventcollective.com.

About ETHOS Event Collective

ETHOS Event Collective is a Destination and Event Management Company that helps meeting and event planners stay ahead of increasing demands while supporting the people and places that make the experiences we create possible. We call it Purposeful Planning and it’s how we ensure results for both company and community long after a meeting or event has ended. To learn more visit www.ETHOSEventCollective.com.

Media Contact:

Lexi Matias
Marketing Manager
lexi.matias@ethoseventcollective.com

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Image 1: Meryl Hill

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This content was issued through the press release distribution service at Newswire.com.

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Learn about native gardens or sit by a bonfire at unique weekend events in Milton | inHalton

Learn about native gardens or sit by a bonfire at unique weekend events in Milton | inHalton


By Jeffrey Allen

Published July 22, 2022 at 3:08 pm

A couple of unique events are happening in Milton this weekend.

Tonight, July 22, at 9 p.m. a giant bonfire is being held at Chudleigh’s Entertainment Farm, 9528 Regional Road 25 in Milton.

Participants are invited to sit back and sip cider with friends and neighbours. Enjoy a taste of cottage life, listen to live music and bask under the night sky.

For more information on the event or to register, visit here.

A Backyard Pollinator Garden Tour is being held tomorrow (Saturday, July 23) from 2 to 4 p.m.

Led by Margaret and John Beaudette, participants will learn how to build a garden with plants native to southern Ontario.

The free tour is being held at 11255 Guelph Lin in Campbellville. To register, visit the website.


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Mega events, QNV 2030 unique components of Milipol

Francois Jullien, Milipol Events Director

Doha: The Qatar National Vision (QNV) 2030 framework and Qatar’s hosting of mega events are significant constituents of the Milipol Qatar structure, Francois Jullien, Milipol Events Director, told The Peninsula. 

Jullien highlighted the QNV 2030 pillars of economic, social, human and environmental development and noted that these pillars require a stable and secure environment to thrive.  “You cannot achieve development without ensuring that your state is secure, and Qatar is one of the safest countries,” Jullien said. 

“Qatar has been holding a series of large, mega-events, including the next FIFA World Cup. This goes on until 2030 with the Asian Games, taking place also in Qatar. So security in Qatar is paramount in delivering these safe mega events. Many security needs are linked to the organisation of mega events in terms of authentication, access, control, crisis management, intervention, and preventing cybercrimes.

“So being in Qatar in 2022 makes sense, and it will continue to do so because of all the new mega events that will come,” he added.  

Speaking on the uniqueness of Milipol events, Jullien noted that Milipol Paris, Qatar and Singapore are the only exhibitions dedicated to homeland security. He said in Qatar, Milipol has incorporated civil defence structures due to Qatar’s needs visible in the booming construction and policy to regulate the building and maintenance of high rises. 

Besides, Milipol events involve three crucial qualities: innovation, exhibition, and networking. 

“The Milipol network is significant. Our job is to bring new technologies and innovation to each market. Milipol is a place where minds meet. The conference programmes and seminars are essential because we want to deliver high-value content. When you organise such a show, you want to make sure that people can meet. During the show in places like this, you can create useful connections for business or otherwise because it’s peculiar to homeland security and making this community is also very important.”

Jullien said Milipol would encourage new technologies, innovations, start-ups and prototypes. 

“This is how we need to go; we need to evolve, go deeper into technology and allow smaller start-ups to be able to present before they have final products. That’s important to us. We are a network, so we should make each venue benefit from what the others are doing. That kind of cross-fertilisation is unique to our network, and we leverage that to make our shows better,” Jullien stressed.

The Milipol official lauded the close relationship between Qatar and France. The 14th Milipol Qatar recorded QR592m deals signed among participants. Over 11,000 visitors attended the exhibition.

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Guest Star Chefs Are Creating Unique Culinary Events At Auberge Resorts

Guest Star Chefs Are Creating Unique Culinary Events At Auberge Resorts

When Nina Compton, the James Beard Award winning chef of New Orleans’ Compère Lapin and Bywater American Bistro, sets up shop at Malliouhana, Auberge Resorts Collection in July, she’ll be returning to the Caribbean, the region of her birth, although to Anguilla instead of St. Lucia. For a month, from July 22nd to August 19th, she’ll be the headliner of the resort’s “Flavors of Malliouhana,” a series that started with chef JJ Johnson in March and is intended to reflect the island’s rich culinary traditions combined with a guest chef’s singular focus. She’ll be on property the first three days, doing immersive events and cooking demonstrations with dishes such as ricotta gnocchi with jerk summer corn and tomatoes; her dishes will then remain on the menu for the rest of the month.

It’s an honor to be partnering with Malliouhana, Auberge Resorts Collection,” said Chef Compton. “Having grown up in St. Lucia, where I initially discovered my passion for food, it is an honor to bring my skills back to the Caribbean. I’m excited to partner with Malliouhana to create a memorable menu that not only remains true to my roots but also provides creative twists to some Anguillian classics.”

By creating this series, part of Auberge Resorts Collection’s Taste of Auberge, the hotel group is responding to the growing interest in culinary travel the last few years fueled, according to recent studies, by the increase of food experiences on social media largely by food enthusiast millennials, the rise in discretionary income and proliferation of food festivals. So, a little cross pollination of bringing chefs from other cities in to create their signature dishes with local ingredients and influences, often alongside the resort chef definitely adds to a resort’s appeal. Guests obviously benefit from experiencing the cuisine from in demand restaurants without traveling to that destination and trying to get a reservation.

Just before Nina Compton’s stint at Malliouhana, from July 13th-16th, Tyler Cole’s inventive restaurant Uchi which originated in Austin and now also has branches in Denver, Dallas, Houston and Miami is taking over the Prospect restaurant at Aspen’s Hotel Jerome, Auberge Resorts Collection to showcase his out of the box takes on Japanese cuisine. Also in July, from the 1st to the 10th, New York’s creative, secret cocktail bar Please Don’t Tell is taking over the bar and culinary destinations within Etéreo, Auberge Resorts Collection on Mexico’s Riviera Maya mixing Mayan influences and distinctive urban mixology.

Diners hoping to score a table at San Francisco’s perennially in demand Saison known for its impeccably sourced ingredients, wood fired cooking and creative $298 tasting menus can get a glimpse of the restaurant’s two star Michelin creations at Commodore Perry Estate, Auberge Resorts Collection on November 4th and 5th. The chefs will be working with local ingredients from the property’s Austin location, conducting a fire cooking workshop and multicourse dinner accompanied by the unique fermentations foraged and created by the restaurant’s team. Also in November, on the 26th, Mexican and New Mexico cuisine will fuse with a collaboration between chef Jorge Vallejo of Mexico City’s Quintonil, a regular on the World’s 50 Best Restaurants list, and Executive Chef Pablo Peñalosa of the restaurant Skyfire at Bishop’s Lodge, Auberge Resorts Collection in Santa Fe.

Another upcoming collaboration promises to deliver not just an assortment of different flavors but also health-encouraging benefits. Hacienda AltaGracia, Auberge Resorts Collection, the wellness retreat near a long life Blue Zone in Costa Rica, is welcoming chef Shennari Freeman of New York’s Cadence, named one of the best new restaurants of 2021 by the New York Times. Guests can learn the keys to the restaurant’s plant-based Southern soul cuisine with wellness and sustainability as a focus in curated dinners, a cooking class and holistic health workshops. All will be held from July 7th-17th.

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Greeley Mob Mixer draws interest for unique, flash mob-style networking events in Greeley

Greeley Mob Mixer draws interest for unique, flash mob-style networking events in Greeley

What began as a way for the community to support local businesses, restaurants, breweries and distilleries in Greeley has grown into a much-anticipated monthly networking event where many have formed friendships and business relationships.

The Greeley Mob Mixer, a monthly networking event, is the brainchild of Katie Gale, Ryan Roth, Beryl Durazo, Brady Hull and Emilio Vallejos. The five friends come from different backgrounds and businesses such as insurance, finance, the nonprofit sector and radio broadcasting.

“What we really wanted to do was bring the community out and have them start frequenting restaurants and other businesses that were really slow,” Gale said. “We knew they (local businesses) were having some slow times and it was hard to get business during COVID, so we wanted to help boost business.”

The group came up with the name “Greeley Mob Mixer” since the event would be like a flash mob-style gathering set for a pre-planned day at a specific location in Greeley. And with Wednesdays typically being a slower day during the week for businesses, Gale and the crew decided to host the event on Hump Day.

“So we would bring a ton of people into the business, they would get business, and all of us as business owners would be able to network, talk to each other and exchange business cards,” Gale said. “So it’s a win for us as business owners of the community and a win for the businesses that we frequent.”

The Greeley Mob Mixer is a once a month networking event that is free and open to all members of the community. (Photo credit Greeley Mob Mixer)

The group’s most recent mixer took place Wednesday at WeldWerks Brewing Co., 508 8th Ave., with nearly 100 people shuffling into the brewery to enjoy some craft beer and food from the brewery’s new restaurant, The Annex. As bartenders kept the taps flowing filling up glasses, the kitchen was busy cranking out orders of fries with lemon aioli, pork belly lettuce wraps and other delectable eats.

In addition to WeldWerks, the group has hosted events at John Galt Coffee Co., The Kress Cinema and Lounge, Stella’s Pinball Arcade and Lounge and Crabtree Brewing Company.

In the beginning, the five founders figured they might get a draw of 15-20 people to each event. But news of the mob mixer spread like wildfire, and now, events draw two to three times that amount each month.

“The ability to mob a local business is awesome, and to give a business that exposure, especially when we were coming out of COVID, and have people spend money is really something special,” Roth said. “We have developed a really loyal following.”

Former Greeley city manager Roy Otto, The Myster Collection founder Paul Noffsinger and entrepreneur Zander Marshall were just a few of the folks who attended the event.

As mobbers made their way through the door at WeldWerks, Roth was busy greeting them and encouraging attendees to toss a business card into a bucket for a chance to win prizes.

First-timers and regulars were both welcomed with open arms and enthusiasm.

There are no dues, fees or cost to attend the mixers. All the founders ask is that you support the business hosting the event by purchasing food, drinks or other items. Mobbers can attend as many, or as few, mixers as they wish, and registration is not required to attend — just show up, meet people and have a good time.

“If you can make it great, if not, there will be another one next month,” Roth said. “It’s been amazing, and it truly is the highlight of my month to see this thing we have created and see these individuals together that might not have otherwise met one another and connected.”

GREELEY, CO – APRIL 13:Attendees mix and chat during the April Greeley Mob Mixer at WeldWerks Brewing Co. in Greeley April 13, 2022. (Alex McIntyre/Staff Photographer)

The best part of attending mob mixers is that there’s no pressure to get up in front of everyone to give a 45-second elevator speech about who you are, what you do and why you are at the event.

With mixers taking place in a new location every month, mobbers get the opportunity to visit businesses and organizations they might not typically have the opportunity to go to or have even known about.

The group is also working on other ideas for mixers such as a poker walk in downtown Greeley in August.

“We just want to mix things up, socialize and have fun,” Roth added.

Mixers take place at 5 p.m. the second Wednesday of the month. Locations of the mixer are posted on the group’s Facebook page at https://bit.ly/37hZdY8.

Attendees don’t have to be business owners to attend. Staff, employees and representatives of businesses, organizations and nonprofits are also welcome to attend the monthly mob mixers. All ages are also welcome to attend.

For more information, questions or to inquire about becoming a host business for an event, email the Greeley Mob Mixer at greeleymobmixer@gmail.com.

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Big C Relays return with strong field, unique events

Big C Relays return with strong field, unique events

The boys begin their 3200M race at the Big C Relays in The Dome, April 8, 2022. (Anne Raup / ADN)

After a two year absence, the Big C Relays returned Friday, bringing a big chunk of the state’s top track and field athletes to the Dome in Anchorage.

And the return of the Big C meant the return of some of the state’s most unique and idiosyncratic track events.

Dimond won one of the more quirky events of the meet — the Swedish Relay. The race features teams running two boys and two girls with each running going a different distance — 100 meters, followed by 200, 300 and 400.

James Reinbold, Preston Skeete, Cylena Snow and Avrey Campbell won the first heat and stood by to see if their time held up.

“It’s stressful,” Snow joked.

“Being first has its ups and downs,” Skeet said. “You set the pace, but you’ve got to watch everyone else and hope.”

“It’s not like any other meets we have,” Reinbold said. “You’re coming through different lanes and keep on switching back.”

Another longtime tradition of the relays is the inclusion of a pentathlon. The competition includes the high jump, the shot put, the 100, 800 and 300-meter hurdles.

Quinton Metcalf took over this year for his father Shane Metcalf as meet director. He said the when the Big C started in 2008, the pentathlon was conceived as an opportunity to highlight not only track prowess, but students work in the classroom and in the community.

Coaches nominate athletes and there a submission process that includes academic achievements and community impact. There is a limit of six boys and six girls, enough to fill each lane on the Dome track.

“It’s just great because the Alaska track season is so short,” Metcalf said. “It’s two months. You have kids come in here who are good runners but aren’t good jumpers. Maybe they’re throwers and don’t normally run. It’s fun getting to witness them give their best effort.”

The event is a showcase for athletes and allows them to not only bolster their resume, but also explore events they’d normally not compete in. It also only counts as one event so they can compete in their regular events.

“Even though it’s five events, it’s viewed as one,” Metcalf said. “So they can still be in three other things. If they’re good hurdlers, go do the hurdles. If you’re great at jumping or throwing, go do it.”

One of the day’s first events was a standard — the 3,200, with two of the state’s best squaring off.

West’s Payton Smith won the race 11:41.65, followed closely by Chugiak’s Campbell Peterson, who ran it in 11:42.86.

The two were running on their own for much of the race, with the next closest finisher almost 40 seconds off the pace.

Peterson is coming off a cross-country season in the fall where she placed second at state in the Division I field. Smith also placed in the top 10.

“I’ve been preparing for a couple weeks now and have got back in the swing of things,” said Peterson.

The relays continue Saturday with field events starting at 7:45 a.m.

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Pokmon Go Fest 2022 includes both global and unique city events

Plus a special bonus finale.

This year’s Pokémon Go Fest will return to hosting in-person events in three select cities, as well as a two-day global event you can play wherever you are.

The global event will be held on Saturday 4th and Sunday 5th June, and also offer a “bonus finale event” on Saturday 27th August.

Sandwiched in the middle of all that will be three distinct city-focused events held in Berlin, Seattle and Sapporo.

If you fancy attending in Berlin, you’ll be able to do so from Friday 1st to Sunday 3rd July.

Seattle’s dates are Friday 22nd to 24th July. Finally, Sapporo’s dates are Friday 5th to Sunday 7th August.

It’s interesting to see Pokémon Go Fest shift the cities it traditionally calls home – Chicago in the US, which has hosted the event each year since it began in 2017, and Dortmund in Germany, home to previous Go Fest and Safari Zone events.

It remains to be seen whether other cities will hold different events throughout the year, and how many Safari Zone meetups may lie on the cards. (Hopefully the UK will get another too, following the long-delayed Liverpool event.)

It’s also interesting to see Pokémon Go’s biggest annual event continue to be made available to all players globally – something which only became the case in 2020 due to global travel restrictions.

“It’s been nearly three years since Pokémon GO Fest 2019 was brought to life in Dortmund, Chicago, and Yokohama, and we’re excited to return to the roots of this annual event while continuing to host the global experience that millions of Trainers have enjoyed,” Niantic said today.

As yet, there’s no word on what will be offered at Go Fest 2022 in terms of in-game content or real-world activities. But if you fancy it, now’s the time to mark your diaries.

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Checkpoint Inhibitors Present Unique Adverse Events, Require Careful Management Strategies in Breast Cancer

Checkpoint Inhibitors Present Unique Adverse Events, Require Careful Management Strategies in Breast Cancer

Most, but not all, immunotherapy-related adverse events (irAE) occur throughout the first 12 weeks of treatment, and can affect any organ, according to La-Urshala Brock, FNP-BC, CNM, RNF, a clinical instructor specializing in breast and gynecologic cancers at the Nell Hodgson Woodruff School of Nursing with Emory University.1

Brock recently presented during the 39th Annual Miami Breast Cancer Conference® about immunotherapy-related adverse event management, in a lecture titled, “Immunotherapy Adverse Effects,” which focused specifically on toxicities associated with pembrolizumab (Keytruda).

In July 2021, the PD-L1 inhibitor pembrolizumab was approved by the FDA to treat patients with triple-negative breast cancer (TNBC) in the neoadjuvant meeting in conjunction with chemotherapy, to be continued as an adjuvant monotherapy after surgery.2

The approval for pembrolizumab was supported by findings from the randomized, multicenter, double-blind, placebo-controlled KEYNOTE-522 trial (NCT03036488).3 Results demonstrated a 37% reduction in the risk of disease progression that precluded definitive surgery, a local/distant recurrence, a second primary cancer, or death from any cause (HR, 0.63; 95% CI, 0.48-0.82; P = .00031).The recommended dose for intravenous pembrolizumab is 200 mg every 3 weeks.2

Notably, this approval also marked the first immunotherapy to treat patients with high-risk early-stage TNBC. However, the introduction of the agent also opens the door for more toxicity management education for nurses who care for patient with breast cancer.

“Immunotherapies present with a novel spectrum of AEs that differ in important ways from those associated with chemotherapy and targeted agents,” said Brock. “When you’re using immunotherapy, truly any organ can be affected. The median onset is 4 to 5 weeks [after beginning treatment], but adverse events can happen as early as when you start the treatment.”

Atezolizumab (Tecentriq), a PD-L1 inhibitor, was granted accelerated approval for TNBC to be given every 3 weeks with weekly nab-paclitaxel (Abraxane) in 2019, but this agent was withdrawn from market, since it was not shown to improve survival in patients with locally unresectable metastatic, PD-L1–positive disease.4

In her discussion, Brock highlighted a wide range of toxicities that are associated with immune checkpoint inhibitiors (ICI)—particularly for patients with TNBC receiving pembrolizumab. Toxicities of interest include dermatitis, endocrine effects, adrenal insufficiencies, lung effects, colitis, hepatotoxicity, and ocular side effects, in addition to a couple rarer immune-related AEs (irAEs).

Dermatitis

ICIs may induce low-grade rashes in many patients. This can include reticular erythema, papules, and plaques. In more rare cases, Stevens-Johnson syndrome or toxic epidermal necrolysis, palmar–planta dysesthesia may also occur.

Effective management of skin-related toxicities involve frequent photo documentation of the toxicity and follow-up photos to track potential changes, as well as consulting a dermatologist to obtain a biopsy. For low-grade toxicities, symptomatic treatment with antihistamines typically prove to be effective. However, for high-grade toxicities, treatment with topical or oral steroids may be appropriate. In addition, if symptoms progress to grade 3, treatment should be withheld, and if symptoms worsen to grade 4, treatment should be discontinued.5,6,7,8

“We hold at this point,” said Brock. “You could think about using rituximab [Rituxan] for treatment. You want to continue steroids until the blisters have resolved completely and then [once] the blisters have resolved, you want to slowly taper the steroids.”

Endocrine Toxicities

Endocrine toxicities occur in approximately 10% of patients receiving pembrolizumab. Nurses should watch for vision changes, weight gain or weight loss, dizziness, constant chilliness or feeling cold, constipation, and hair loss. Other signs of endocrine toxicities include increased headaches or changes in headache patterns, increased heartbeat, increased urination, increased tiredness, increased thirst or appetite, changes in mood, and increased sweating.8

Patients suspected to be experiencing these toxicities should have their thyroid-stimulating hormone (TSH) and free thyroxine (FT4) checked every 4 to 6 weeks with complete blood count (CBC) and comprehensive metabolic panel (CMP).

Adrenal Insufficiency

Adrenal insufficiency, or Addison’s disease, means that the adrenal glands produce insufficient amounts of the hormone cortisol, Brock explained. Signs and symptoms include extreme fatigue, darkening skin or hyperpigmentation, low blood pressure or fainting, abdominal pain, muscle or joint pain, salt craving, weight loss, depression or behavioral changes, and nausea, vomiting, or diarrhea.

For primary adrenal insufficiency, the workup should include assessing morning cortisone and adrenocorticotropic hormone (ACTH) levels, as well as CMP to assess sodium, glucose, potassium, and carbon dioxide.

If a patient has elevated TSH levels but normal or low FT4, then hypothyroidism is the cause. So long as the toxicity remains a grade 1 (TSH < 10 ml U/L or asymptomatic), they may continue receiving the checkpoint inhibitor with continued TSH and FT4 monitoring.

For hypophysitis, or inflammation of pituitary gland, the workup should include assessing morning cortisone as well as ACTH, TSH, FT4, testosterone in men, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen in premenopausal women, and an MRI of the brain with or without contrast with pituitary cuts.

If the hypothyroidism progresses to a grade 2 (TSH > 10 mIU/L or symptomatic), the ICI should be withheld, an endocrinologist should be consulted, and a thyroid hormone supplementation should be implemented. The patients will continue to require TSH and FT4 checks every 6 weeks, but if the severity reduces to a grade 1 event, they may continue treatment.

In the event of grade 3/4 hypothyroidism, the ICI should be withheld until symptoms resolve to baseline with thyroid supplementation.

If a patient has low TSH and high, normal, or elevated FT4 levels, then this person is experiencing hyperthyroidism. As long as the toxicity remains at grade 1, they may continue receiving the ICI with continued TSH and FT4 checks every 2 to 3 weeks.

If the hyperthyroidism progresses to a grade 2, the ICI should be withheld until symptoms return to baseline and an endocrinologist should be consulted. A beta blocker might also be considered.

For grade 3/4 hyperthyroidism, the ICI will need to be withheld until symptoms resolve to baseline with thyroid supplementation. In addition, at this grade, hospitalization may be required if thyroid storm occurs. Prednisone should be considered at a dosage of 1 to 2 mg/kg daily and then put on a tapering schedule.

“With hyperthyroidism, what I want to mention here is that if someone is experiencing symptoms, we can use a beta blocker, but we also still want to be consulting endocrinology,” Brock highlighted. “One of the risk factors here when we get to grade 4 is the risk for thyroid storm. That is why it is important to have endocrinology involved.”

In less than 1% of patients, ICI-mediated endocrinopathy type 1 diabetes mellitus may occur with rapid onset anytime following therapy initiation.

Management for this toxicity involves monitoring serum glucose at baseline and prior to each cycle of ICI. An endocrinologist should be consulted, and generally, lifelong insulin therapy will be required. Once blood sugar is well controlled, the ICI therapy can be restarted.

Lung Toxicity

Pneumonitis equates to inflammation of the lung parenchyma. This irAE occurs between 0% to 10% of patients, but the odds increase when patients receive combination therapy as opposed to monotherapy, as well as if there has been previous thoracic radiation.9-11 The onset time for lung toxicity can range from 2 to 24 months, however, the median onset time is 3 months.

Cough, fever, dyspnea, and chest pain should be evaluated when monitoring for lung toxicity. Patients who experience these symptoms will need a chest x-ray and CT scan. The threshold for obtaining a CT scan of the chest and a pulmonary consultation should be low, noting that CT findings typically lag patient symptoms.

Management includes routine pulse oximetry checks in addition to potential CT scans, as well as administration of high-dose steroids, starting at 1 to 2 mg/kg daily, and tapering across 45 to 60 days. If symptoms return, the steroids may require retapering.

If within 72 to 96 hours of steroid initiation there is no symptom relief, patients should receive infliximab-axxq (Avsola) at 5 mg/kg. In most cases, the addition of immunosuppressants will help to resolve the issue.Infectious workup should include a nasal swab for potential viral pathogens, including COVID-19.

Notably, lung toxicity has been associated with immune checkpoint inhibitors but is an uncommon AE; less than 5% of patients experience this irAE, and less than 1% report high-grade lung toxicity while receiving this type of immunotherapy. In comparison, lung toxicity tends to present more in patients receiving ipilimumab (Yervoy) plus nivolumab (Opdivo), explained Brock.

Colitis

Colitis occurs in approximately 8% to 27% of patients receiving ICIs. Onset of GI toxicities typically appear about 5 to 10 weeks after treatment begins but can occur months after treatment with the ICI has stopped.

Initial workup for colitis should include CBC, CMP labs to assess TSH, c-reactive protein (CRP), HIV, hepatitis A and B; whereas interferon gamma release assay should be used to look for tuberculosis (TB). In addition, stool cultures to identify C. diff, CMB, ova, and parasites are recommended; lactoferrin should identify inflammation of digestive tracts and calprotectin can determine immune bowel disease (≤80 ug/g) vs inflammation (levels on 80 ≥ 1, 60 ug/g); and a CT scan.

At grade 1 severity, the ICI can either continue or be temporarily withheld. Providers should discuss dietary changes with their patients and review hydration strategies, and antdiarrheal administration may also be effective.

If the inflammation progresses to grade 2 level, the ICI should be withheld until symptoms return to grade 1 or less. A GI specialist should be consulted for an EGD/colonoscopy and prednisone should be administered at a dosage of 1 mg/kg daily. In addition, stools should be checked for inflammatory markers, such as lactoferrin and calprotectin. Once the symptom returns to grade 1, the steroids should be tapered across 4 to 6 weeks.

Grade 3 inflammation requires a hold on the ICI. Hospitalization may be required if there is electrolyte imbalance and dehydration. Providers should rule out CMV via colonoscopy and consult a GI specialist. Corticosteroids given at a dosage of 1 to 2 mg/kg day or infliximab at a dosage of 5 to 10 mg/kg daily should be administered.

“With colitis, there could be another rebound,” said Brock. “Someone could resolve back to a ready to a grade 1; if that occurs then, of course, we restart the steroids or increase the steroids and start again—slowly tapering once the symptoms improve.”

If the severity level reaches a grade 4, it is now life-threatening, and treatment should be discontinued permanently.

Hepatotoxicity/Immune-Mediated Hepatitis

Hepatotoxicity or immune-mediated hepatitis occurs in approximately 2% to 10% of patients receiving pembrolizumab and onset usually occurs between 6 to 12 weeks after treatment initiation. Symptoms include drowsiness, jaundice, right-sided abdominal pain, severe nausea or vomiting, increased bleeding, or bruising, decreased appetite, and abnormal liver blood tests (aspartate aminotransferase [AST], alanine transaminase [ALT], and bilirubin).

For grade 1 inflammation (AST or ASLT > upper limit of normal [ULN] to 3.0 and/or total bilirubin 1.0 ULN > 1.5 ULN), ICI treatment may continue but liver function should be monitored 1 to 2 times weekly. For grade 2 inflammation (ASR or ALT > 3.0 ULN to < 5.0 and/or total bilirubin 1.0 ULN to 3.0 ULN with symptoms), the ICI should be held until severity resolves to a grade 1.

In addition, the liver should be monitored every 3 days if the patient is symptomatic. If the symptom reaches statistical significance, after 3 to 5 days they can receive corticosteroids at a dosage of 0.5 to 1.0 mg/kg daily. This will require tapering over 1 month. Lastly, any hepatoxic medication should be halted.

For grade 3 inflammation (ASR or ALT 5 x 20 x ULN and/or total bilirubin >3-10 x ULN with symptoms such as biopsy-fibrosis or cirrhosis), the ICI should be discontinued permanently, and the patient should be monitored every 1 to 2 days. Corticosteroids should be administered at a dosage of 1 to 2 mg/kg/day, and the patient should be referred to a hepatologist.

If the symptom progresses to grade 4 (ASR or ALT >20 x ULN and/or total bilirubin > 10 x ULN, with symptoms such as ascites or encephalopathy), they will need to be hospitalized with daily lab monitoring and consultation from a hepatitis. They should receive methylprednisone at a dosage of 2 mg/kg daily.

Ocular Symptoms

Ocular symptoms typically occur in less than 1% of patient receiving PD-1/PD-L1 inhibitors alone or in combination. Symptoms include eyelid swelling, blurred vision, double vision, or color vision changes, photophobia, painful eye movement, scotomas, proptosis or bulging eyes, and visual field changes.

If a patient appears to be experiencing an ocular toxicity, they should be referred to an ophthalmologist and receive a slit-lamp exam.

Treatment management for uveitis or inflammation of the middle of the eye, and iritis, or inflammation of the iris, are similar. For grade 1 inflammation, ICI treatment should continue but a referral to an ophthalmologist should be made. For grade 2 inflammation (anterior uveisis), the ICI should be held until ophthalmology evaluation and topical or systematic corticosteroids can be administered. These can continue once the issue resolves or returns to grade 1 and the patient resumes ICI treatment.

If symptoms progress to grade 3 (posterior uveitis), the ICI should be discontinued permanently, and systematic and topical corticosteroids should be administered. Lastly, if symptoms become grade 4, not only should the ICI be discontinued permanently, but the patient may need emergency care.

Rare irAEs

In addition, rare irAEs that may present in patients receiving ICIs include myocarditis and pericarditis; nephritis; pancreatitis; musculoskeletal toxicities such as arthritis, arthralgia, myalgia, and myositis; and neurologic toxicities such as peripheral neuropathy, myasthenia gravis, and Guillain-Barré Syndrome.

General Principles of ICI Toxicity Management

In conclusion, for grade 1 toxicities (mild or asymptomatic toxicities), the patient can continue receiving the ICI without steroids or intervention. Patients with grade 1 toxicities may benefit from antihistamines.

For grade 2 toxicities (moderate toxicities), a specialist should be consulted, and steroids should be considered. The ICI should be withheld until the symptom returns to grade 1; if the grade 2 symptoms persist for more than 12 weeks, the ICI should be discontinued.

If symptoms progress to grade 3, the ICI should be held (or, in the case of pneumonitis, discontinued), and prednisone should be administered. A specialist should be consulted, and hospitalization may become necessary. If these symptoms remain consistent, the ICI should be discontinued.

Grade 4 toxicities are life-threatening. Unless the symptom is endocrine-related, grade 4 toxicities signify that the ICI should be immediately discontinued. The patient will need hospitalization, and to continue receiving prednisone. If the steroid does not yield symptom improvement, infliximab should also be considered.

Other important considerations include using a proton pump inhibitor or H2 blocker for gastritis, sulfamethoxazole/trimethoprim/fluconazole for opportunistic infections, and calcium and vitamin D for osteoporosis, Brock noted.

Furthermore, counseling patients and caregivers should involve setting evidence-based expectations for benefits. Patients may have heard of the drug and have misconceptions based on popular stories in the news. It should be clear that benefits taking longer to emerge with immunotherapy compared with treatments like chemotherapy and targeted therapy. Therefore, patients with significant tumor burden or rapidly progressing disease often cannot afford to elect these types of therapies.

For nurses caring for patients beginning immunotherapy, it is essential to emphasize the importance of monitoring and promptly reporting symptoms.

“Emphasize [the importance] of monitoring and promptly reporting symptoms,” Brock urged. “[Teach them to] contact the oncology care team if [they are] experiencing any new signs or symptoms [and to] report any visits to the emergency department and other healthcare providers.”

In addition, patients should also always always carry an immunotherapy wallet. Lastly, patients need adequate irAE management education.

“Discontinuing ICIs because of AEs does not worsen survival,”12 she noted. “Treating irAEs with steroids does not worsen response or survival.”13,14 

References

  1. Brock LA. Immunotherapy adverse effects. Presented at: 39th Annual Miami Breast Cancer Conference®; March 3-6, 2022; Miami Beach, FL.
  2. This Keytruda combination is the first immunotherapy regimen approved for high-risk early-stage triple-negative breast cancer (TNBC). News release. Merck. July 27, 2021. Accessed March 15, 2022. https://bit.ly/3id6Rou
  3. Schmid P, Cortes J, Dent R, et al. Event-free survival with pembrolizumab in early triple-negative breast cancer. N Engl J Med. 2022;386(6):556-567. doi:10.1056/NEJMoa2112651
  4. Roche provides update on Tecentriq US indication for PD-L1-positive, metastatic triple-negative breast cancer. News release. Roche. August 27, 2021. Accessed August 27, 2021. https://bit.ly/3ypzC6K
  5. Weber JS, Postow M, Lao CD, Schadendorf D. Management of adverse events following treatment with anti-programmed death-1 agents. Oncologist. 2016;21(10):1230-1240. doi:10.1634/theoncologist.2016-0055.
  6. Haanen JBAG, Carbonnel F, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [published correction appears in Ann Oncol. 2018;29(suppl 4):iv264-iv266]. Ann Oncol. 2017;28(suppl_4):iv119-iv142. doi:10.1093/annonc/mdx225
  7. Sanlorenzo M, Vujic I, Daud A, et al. Pembrolizumab cutaneous adverse events and their association with disease progression. JAMA Dermatol. 2015;151(11):1206-1212. doi:10.1001/jamadermatol.2015.1916
  8. Freeman-Keller M, Kim Y, Cronin H, Richards A, Gibney G, Weber JS. Nivolumab in resected and unresectable metastatic melanoma: characteristics of immune-related adverse events and association with outcomes. Clin Cancer Res. 2016;22(4):886-894. doi:10.1158/1078-0432.CCR-15-1136
  9. NCCN guidelines for management of immunotherapy-related toxicities. NCCN. Accessed March 18, 2022. https://bit.ly/34TwdEN
  10. Haanen JBAG, Carbonnel F, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [published correction appears in Ann Oncol. 2018 Oct 1;29(Suppl 4):iv264-iv266]. Ann Oncol. 2017;28(suppl_4):iv119-iv142. doi:10.1093/annonc/mdx225
  11. Chen X, Zhang Z, Hou X, et al. Immune-related pneumonitis associated with immune checkpoint inhibitors in lung cancer: a network meta-analysis. J Immunother Cancer. 2020;8(2):e001170. doi:10.1136/jitc-2020-001170
  12. Harbeck, N. Immunotherapy in TNBC: rationale and current clinical standards. Clinic Care Options Oncology. Accessed March 18, 2022. https://bit.ly/3MYh1rf
  13. Brahmer JR, Laccheti C, Schneider BJ, et al. National Comprehensive Cancer Network. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy. American Society of Clinical Oncology Clinical Practice Guidelines. J Clin Oncol. 2018;36(17):1714-1768. doi:10.1200/JCO.2017.77.6385
  14. Emens, LA, Adams S, Cimino-Matthews A, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guidelines on immunotherapy for the treatment of breast cancver. J Immunother Cancer. 2021; 9(8):e002597. doi:10.1136/jitc-2021-002597
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Huge amount of snow poses unique challenge for snowcross event organizers

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Races taking place at Timmins snowdump on Spruce Street South this Saturday and Sunday

A dozer was brought in Wednesday to do some preliminary clearing of snow at the snowdump on Spruce Street South in preparation for the Triple Crown Pro Snowcross event being put on by the Canadian Snowcross Racing Association this Saturday and Sunday. RON GRECH/The Daily Press
A dozer was brought in Wednesday to do some preliminary clearing of snow at the snowdump on Spruce Street South in preparation for the Triple Crown Pro Snowcross event being put on by the Canadian Snowcross Racing Association this Saturday and Sunday. RON GRECH/The Daily Press jpg, TD

Can there actually be too much snow for a snowcross racing event?

Apparently so.

Ken Avann, president of the Canadian Snowcross Racing Association which is organizing the two days of racing in Timmins this weekend, said they had to cancel the kids’ events with the mini-snowmobiles because of the limited area of space for racers due to the amount of snow.

“The fact that we have so much is great, because we can proceed with the event,” said Avann. “The fact that we have as much as we do have – which is way more than we need – it does create some challenges for sure.

“For example, our footprint that we have inside the snowdump here is so small, we don’t have enough room to get all the racers in here.”

Typically, CSRA races include novelty events for children, some as young as four.

“There’s just not enough space for them,” said Avann. “So the kids, which represents about 60 racers, we’ve asked to stay home this weekend and we’re going to let them race at another event being held at one of the ski resorts at the end of the season to make up for it.

“We have to bring in about 60 to 70 teams. They’ll fill up all the space that’s here, in the three lots.”

On Wednesday and Thursday, crews began moving snow and starting the work to create a half-mile long track, with jumps at various points.

“We’re going to have a great track. Everything is going to be elevated on top this year. So in that sense, we’re going to have a great show for the crowd.”

Avann said they’re expecting racers from all over Ontario and parts of Quebec.

“They’re going for a national points championship. We run a nine-race series and these guys get points every time they race for a championship at the end of the season. We also did a Triple Crown with our northern events – Sault Ste. Marie, Sudbury and Timmins. So this is the final of that Triple Crown challenge and there will be a big award presented to the pro open racer who wins that Triple Crown championship.”

Avann said the racers’ group of 60 to 70 teams will account for about 700 people, which includes mechanics and family members.

“Then we’re expecting over a thousand people per day for spectators. So, we’re looking at over the weekend probably close to 3,000 people here, so it’s significant.

“Some people are here now already,” he said on Wednesday. “They’re riding the trail systems and staying at the hotels and they’re spending their money.”

Avann said the economic spinoffs to host communities tends to range between $700,000 to $1.3 million.

“That’s what the economic impact studies have shown and that’s based on hotel rooms, overnight stays, the food and beverages that are sold, the hardware stores, gas, all that kind of stuff.

“So it’s a great boost for the city.”

With no on-site parking available, Avann said spectators are going to be encouraged to take advantage of shuttle services that are going to be available this Saturday and Sunday.

“Once you get the racers in here, the lots are going to be full and the ends will be fenced so there will only be walk-in traffic.”

The Triple Crown Pro Snowcross event put on by the CSRA is being held at the Timmins snowdump on Spruce Street South this Saturday and Sunday. Tickets are available each race day at the front admission gates.

Visit snowcross.com/timmins for more details about admission fees and scheduled races.