P3-218 - Severe immune-related adverse events (irAE) induced by nivolumab at our institution

Abstract

Nivolumab has promising efficacy, but clinicians have to take cautions of immune-related adverse events. Methods: We conducted a retrospective analysis to assess the efficacy and safety profile of nivolumab in patients with non-small-cell cancer (NSCLC) who received nivolumab at our institution from December 2015 to June 2017. Results: The median age was 68 years. Fifteen patients had adenocarcinoma and seven had squamous carcinoma. Radiologic response: PR/SD/PD/NE:6/4/8/4 (response rate 27.3%, 95%C.I. 10.7%-50.2%). There were two severe irAEs. A 76-year-old woman who had no smoking history presented with left eyelid ptosis and grade 4 creatine phosphokinase elevation after the 2nd cycle of nivolumab monotherapy. She was diagnosed with lung adenocarcinoma which had EGFR mutation. Dyspnea and muscle weakness developed rapidly with an acute exacerbation. We diagnosed her with myasthenia gravis based on the symptoms and the detection of anti-acetylcholine receptor antibody. She was received plasmapheresis and intravenous immune globulin followed by low dose prednisolone. Her symptoms gradually improved. A 63-year-old man presented with grade 2 arthritis who was diagnosed with rheumatoid arthritis after the 11th cycle of nivolumab monotherapy. He had lung adenocarcinoma with no EGFR mutation. His arthritis condition remarkably improved after the administration of steroids but the tumor was progressed. After the re-administration of the 3rd cycle, he presented with impaired awareness with elevated levels of plasma glucose (1208 mg/dL). We suspected fulminant type 1 diabetes mellitus. He was transferred to a special hospital and later, his condition improved. To avoid severe irAEs, a close cooperation with other departments is essential. Before the administration, we should assess patients carefully using side effect-checklists.