Immune-related adverse events: The experience of a community hospital

Abstract

Abstract Background Treatment with immune checkpoint inhibitors (ICPi) has revolutionized cancer treatment over the past few years. Despite the clinical benefits, there is a wide range of toxicities related to the mechanism of action of such group of therapies. Almost every system of organs may be affected. Although rare, fulminant and even fatal toxicities may occur and so, high level of suspicion is the key element to detect and treat them. The purpose of this analysis was to present real world data of programmed death-1 receptor (PD-1) and its ligand (PD-L1) blockade immune-related toxicities in a population of patients treated in a Community Hospital. Methods A descriptive retrospective analysis of 65 consecutive patients with advanced non-small cell lung cancer (NSCLC), thymoma, head and neck cancer, urothelial and clear cell kidney cancer treated between February 2016 and December 2018 with anti-PD-1/PD-L1 checkpoint inhibitors, was performed. The variables analyzed were the prevalence of toxicities, evaluated according to the system of organs affected and the drug used, their severity according to the Common Terminology Criteria for Adverse Events (CTCAE) classification (v 5.0) and timing of onset. Analyses were performed with use of SPSS v.18 software. Results On our population, 94% received treatment with anti-PD-1 checkpoint inhibitor and 89% had NSCLC. Treatment-related adverse events (AE) were observed in 40% of the patients, for any AE. Grade 3-4 toxicities were reported in 6,2% of the patients. Rheumatologic and cutaneous AE were the most frequent ones. They were all reported amongst patients treated with anti-PD-1 checkpoint inhibitors. The reported treatment-related AEs for the nivolumab and pembrolizumab-treated groups were 42,9% and 30,4% (any AE) and grade 3-4 AEs were 7,1% and 4,3%, respectively. No deaths related to toxicity were documented. Rheumatologic and cutaneous AEs were the earliest ones to appear, median time of onset 4 and 6 weeks respectively. Pneumonitis was the latest toxicity, with a median time to appearance of 45 weeks. Conclusion The data we present here represents an heterogeneous population in real world settings and it similar to the literature. Implementing careful follow-up for immune related events contributes to promptly diagnose and treat. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.