Analysis of the management of immunotherapy-derived toxicity in the Stockholm region.

Abstract

e15069 Background: The debut of immune-checkpoint inhibitors (ICPis) has changed the prognosis of many cancer patients. The immune-related adverse events (irAEs) caused by these monoclonal antibodies are common and can affect nearly any organ system. International guidelines on management of irAEs have been published in recent years. The aim was to investigate the identification and management of irAEs in the Stockholm region, as well as how the patients respond to the management they received. Methods: All adult patients who had received ICPis at the Karolinska University Hospital in 2018 were included. Patients who had enrolled in another study on ICPis were excluded. 62 eligible patients enrolled. Data was collected from the patients’ medical records. In addition to the irAEs documented by clinicians, irAEs were also identified retrospectively. Variables recorded were grade of irAE, management, date of first documentation and date of re-challenge, among others. Management was compared to the guidelines. Descriptive statistics as well as linear correlation analysis and Kaplan-Meier analysis were then performed. Results: 62 patients proved eligible. 121 irAEs were recorded. Nurses at Advanced Home Health Care (AHHC) were first to document grade 3-4 irAEs in 58% of the cases. Kaplan-Meier analysis (p-value 0.043) showed that patients whose irAEs were managed according to the guidelines reached re-challenge sooner. A negative correlation (p-value 0.003) was observed between management according to guidelines and identification by a clinician. Conclusions: Increased knowledge at AHHC and at oncological clinic is necessary to improve the identification and management of irAEs.