OA03.05 Tocilizumab for the Management of Immune Mediated Adverse Events Secondary to PD-1 Blockade: Overall Survival Analysis: Topic: Medical Oncology

Abstract

Immune checkpoint inhibitors are associated with unprecedented clinical benefit in patients with lung cancer. However, they are also associated with a unique spectrum of immune mediated adverse events (irAEs). While the standard of care for initial management of irAEs are corticosteroids, the management of steroid-refractory events is poorly defined. The character and clinical course of irAEs were abstracted from the medical record and analyzed. The dose of tocilizumab was 4 mg/kg given IV over 1 hour. C-reactive protein was drawn at first nivolumab infusion and q 2 weeks (and with irAEs) thereafter. Of the initial 87 patients that were treated with nivolumab, 34 required tocilizumab (39.1%). All pts were on corticosteroids (median dose - 60 mg prednisone equivalents). Clinical improvement (defined as either documentation of resolution of symptoms or hospital d/c within 7 days) was noted in 27/34 pts (79.4%). Median time to discharge was 4 days (range 1-27). Median CRP at initial tocilizumab dose was 100.5 mg/L (2.0 -350.4). There was no adverse effect on median overall survival between patients that received tocilizumab versus those that did not (6.1 vs. 8.7 months; p = 0.37). There was a trend towards inferior overall survival if patients required more than 1 dose of tocilizumab, but it was not statistically significant HR (95% CI) - 1.72 (0.87-3.37; p = 0.11). Tocilizumab is a therapeutic option for the management of irAEs for patients already on corticosteroids. There was no evidence of an adverse effect on overall survival with tocilizumab therapy.