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17-09-2019 | Oncology | News | Article

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Notable number of patients taking immune checkpoint inhibitors hospitalized with irAEs

medwireNews: Patients receiving immune checkpoint inhibitor (ICI) treatment have an increased risk for being hospitalized with immune-related adverse events (irAEs), particularly if they are older or taking combination treatments, researchers report.

“We observed that nearly one quarter of hospitalized patients with solid tumors in an academic center had received or were actively receiving ICIs for treatment of cancer,” the team comments, adding that 23% of these patients had confirmed irAEs.

They therefore stress that “with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.”

Aanika Balaji (Johns Hopkins University, Baltimore, Maryland, USA) and colleagues evaluated all 443 patients admitted with solid malignant tumors, most commonly thoracic and genitourinary tumors, to Johns Hopkins Hospital, over a 6-month period.

Twenty-six of these patients were actively receiving ICI treatment at time of admission, while 74 had completed or stopped ICI treatment prior to admission.

Monotherapy with anti-PD-1 or PD-L1 agents was the most common ICI treatment, received by 69% of patients, mainly nivolumab (34%), with a median of one dose received prior to hospitalization.

In all, 23 of the 100 ICI-treated patients were admitted with confirmed cases of irAEs, which in 65% (n=15) of patients were of grade 3 or above. The most common irAEs were pneumonitis and colitis.

“Of importance, these [23] patients accounted for 5% of the entire cohort of hospitalized oncology patients—both ICI and non-ICI treated—in accordance with published clinical trial data,” the researchers report.

And they note that patients who had received combination ICI treatment were almost seven times more likely to develop irAEs than those who received monotherapy, while the risk was increased more than five times for patients older compared with younger than 65 years.

Encouragingly, the team reports that a high percentage of irAEs resolved or improved, at 65%, with two irAEs completely resolved ─ both of which were grade 2 toxicities ─ and 13 improved, whereas the remaining eight irAEs worsened.

Multidisciplinary care was required by 91% of those with irAEs, leading the researchers to suggest that “[h]ospitals and oncology centers may consider conducting internal audits to identify site-specific service needs for patients with irAEs,” adding that “[t]hese data may support the creation of subspecialist outpatient clinics and medicine training programs for organ specialists in irAEs.”

Fatality from irAEs “was a rare event,” Balaji et al point out in the Journal of Oncology Practice, with just three deaths occurring.

Two of the deaths could be attributed to the development of corticosteroid-refractory toxicities – pneumocystis and nephritis ─ while the third resulted from solid organ transplantation rejection. 

By Hannah Kitt

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

J Oncol Pract 2019; doi:10.1200/JOP.18.00703

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