Ipilimumab (IPI), nivolumab (NIVO) and pembrolizumab (PEMBRO) can induce immune-related adverse events (IrAEs). We describe the IrAE’s associated with 64 patients (pts). There were 20 pts treated with IPI and 25 pts treated with NIVO, 18 pts received PEMBRO alone or in combination with either epacadostat or Talimogene Laherparepvec (T-VEC), and 1 pt was treated with combination of IPI and NIVO.
Retrospective data from 64 pts were used treated either in an expanded access programme, clinical trial setting or post-registration protocol.
A total of 64 pts (33 males, 31 females) were analyzed. Three pts with metastatic malignant melanoma (MMM), 18 with non-small cell lung cancer (NSCLC), 2 with renal cell carcinoma and 2 with Hodgkin’s disease were treated with NIVO and 20 with MMM received IPI. The PEMBRO group consisted of 3 breast cancer, 2 ovarian, 1 stomach and 12 MMM pts. One NSCLC pt received combination of IPI and NIVO (1 cycle). In total 167 cycles of NIVO (median = 4, range 1-16), 123 cycles of PEMBRO (median = 4, range 1-26), and 64 cycles of IPI (median = 4 cycles, range 1-4) were administered. Seven IrAEs are described in 15 IPI treated pts. These included endocrinopathy in 3 pts, colitis in 3 pts (1 required infliximab) and hepatitis in 1 pt. Among the pts treated with NIVO, 7 IrAEs were documented. These included pneumonitis in 2 pts, skin rash in 3 pts, mild diarrhea in 1 pt and mild uveitis in 1 pt. One pt developed autoimmune thrombocytopenia, nephritis, and PRES (posterior reversible encephalopathy syndrome). Three chest infections were documented including pulmonary tuberculosis in a NSCLC pt. Among the pts treated with PEMBRO, 10 IrAE were documented. These included 4 dermatological, 1 Bell’s palsy, 3 mild diarrhea and 2 hypothyroidism. The pt receiving combination IPI and NIVO had grade 4 skin toxicity. No IrAE related deaths were document.
A plethora of irAEs are described with anti-PD1 and anti-CTLA4 antibodies. Colitis was more common with IPI while pneumonitis more common with NIVO. Prompt diagnosis of IrAE’s will result in decreased morbidity and mortality.
Prof Bernardo L. Rapoport
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B.L. Rapoport: MSD (advisory board, consultancy, speaker engagements, and contract research); BMS South Africa (advisory board, consultancy, speaker engagements, research grant and contract research); Amgen South Africa (advisory board, consultancy, speaker engagements, and contract research). All other authors have declared no conflicts of interest.