Immune checkpoint inhibitors (ICIs) have revolutionised the treatment of multiple cancers. However, they are associated with a spectrum of immune-related adverse events (irAEs). Infliximab is a recommended treatment for corticosteroid refractory irAEs, but real-world data is limited.
We conducted a retrospective review of patients in our institution who received infliximab for irAEs between May 2021 to July 2022. Data was correlated against internal guidelines which require upfront testing for TB, HIV, VZV and Hepatitis B and C.
Over this period, 31 patients received infliximab (male n=20). Median age 66.7 years (range: 33-86). Seventeen patients (54.8%) had melanoma, 6 (19.4%) non-small-cell lung cancer, 4 (12.9%) renal cancer, 3 (9.7%) gastrointestinal cancer and 1 (3.2%) uterine cancer. Eighteen (58.1%) patients received ipilimumab/nivolumab combination, 7 (22.6%) pembrolizumab containing regimes, 3 (9.7%) nivolumab, 2 (6.5%) durvalumab and 1 (3.2%) patient received ipilimumab single agent. Highest grade irAE was Grade 3 in 71.0% (n=22), G2 in 19.4% (n=6), G4 in 6.5% (n=2) and G5 in 3.2% (n=1). Gastrointestinal irAE accounted for 87.1% (n=27) of the cohort, 9.7% of patients (n=3) had rheumatological irAE, with 1 case of pneumonitis. The median number of ICI cycles prior to infliximab treatment was 3 (range 1 to 29). Median number of infliximab doses was 2 (range 1 to 3). ICI treatment was discontinued after irAE requiring infliximab in 25 patients (80.6%). All patients received corticosteroids before infliximab. Twenty-four patients (77.4%) were tested for TB (T-Spot test) prior to infliximab initiation. All patients tested received negative results. Testing rates for Hepatitis B and C was 100%, while 93.5% of patients (n=29) were tested for HIV. Testing rates for VZV was 58.1% (n=18). Two patients developed shingles post infliximab and were treated with aciclovir. No patients experienced reactivation of TB or hepatitis post infliximab treatment.
In our institution, most patients treated with infliximab had received ICI therapy for melanoma. The most frequent indication for infliximab was gastrointestinal toxicity. Aside from shingles, no post-infliximab treatment infections were reported in this cohort.
The Royal Marsden NHS Foundation Trust.
Has not received any funding.
D. Cunningham: Financial Interests, Institutional, Research Grant: MedImmune/AZ, Clovis, Eli Lilly, 4SC, Bayer, Celgene, Leap, Roche; Non-Financial Interests, Personal, Advisory Role: OVIBIO. I. Chau: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Eli-Lilly, MSD, Roche, Merck-Serono, AstraZeneca, OncXerna, Pierre Fabre, Boehinger Ingelheim, Astella, Incyte, GSK, Sotio, Daiichi Sankyo, Eisai; Financial Interests, Personal, Other, DMC chairman: Five Prime Therapeutics; Financial Interests, Personal, Invited Speaker: Eisai, Eli-Lilly, Servier; Financial Interests, Institutional, Invited Speaker: Cilag-Janssen, Eli Lilly. N. Starling: Financial Interests, Personal, Advisory Board: GSK, Novartis, MSD Oncology, Servier, AstraZeneca, Pfizer; Financial Interests, Personal, Invited Speaker: Clinical Options, Eli Lilly, Pierre Fabre, Amgen, Merck Serono; Financial Interests, Institutional, Research Grant, Sept 2017 (24m) Paid to institution research: Merck; Financial Interests, Institutional, Research Grant, Nov 2017 (48m) -Paid to institution research fund: AstraZeneca; Financial Interests, Institutional, Research Grant, Jan 2018 - Paid to institution research fund: Pfizer; Financial Interests, Institutional, Research Grant, July 2018 (36m) Paid to institution research fund: BMS. S. Popat: Financial Interests, Personal, Advisory Board: Boehringer Ingelheim, Novartis, Amgen, Janssen, Daiichi Sankyo, AstraZeneca, Bayer, BMS, Blueprint, Merck Serono, Guardant Health, Beigene, Takeda, Lilly, Seattle Genetics, Turning Point Therapeutics, Xcovery, GlaxoSmithKline, MSD, Pfizer, Sanofi; Financial Interests, Personal, Expert Testimony: Roche; Financial Interests, Personal, Invited Speaker: Medscape, VJ Oncology, Touch Medical; Financial Interests, Personal, Other, Journal Deputy Editor, Lung Cancer: Elsevier; Financial Interests, Institutional, Other, Sub-investigator: Amgen; Financial Interests, Institutional, Invited Speaker: Ariad, AstraZeneca, Roche, Boehringer Ingelheim, Celgene, Daiichi Sankyo, GlaxoSmithKline, Takeda, Trizel, Turning Point Therapeutics, Roche, Janssen, BMS, Lilly; Financial Interests, Institutional, Other, Sub-Investigator: MSD, Blueprint, Seattle Genetics; Financial Interests, Institutional, Research Grant: Guardant Health; Non-Financial Interests, Personal, Leadership Role, Chair of Steering Committee, Unpaid: British Thoracic Oncology Group; Non-Financial Interests, Personal, Officer, Thoracic Faculty, Unpaid: European Society of Medical Oncology; Non-Financial Interests, Personal, Leadership Role, Foundation Council Member, Unpaid: European Thoracic Oncology Platform; Non-Financial Interests, Personal, Advisory Role, Mesothelioma Task-force Member, Unpaid: International Association for the Study of Lung Cancer; Non-Financial Interests, Personal, Invited Speaker, Unpaid: Mesothelioma Applied Research Foundation; Non-Financial Interests, Personal, Advisory Role, Honorary Clinical Advisor, Unpaid: ALK Positive UK; Non-Financial Interests, Personal, Advisory Role, Research Advisory Group Member, Unpaid: Ruth Strauss Foundation; Non-Financial Interests, Personal, Advisory Role, Scientific Adivsory Board Member, Unpaid: Lung Cancer Europe. M.E.R. O'Brien: Financial Interests, Personal, Advisory Board, virtual ad board: Puma, Sanofi; Financial Interests, Personal, Advisory Board: iTeos, Amgen, MSD, Pierre Fabre; Financial Interests, Institutional, Invited Speaker, we host clinical trials, PI for MSD pearls trial: MSD; Non-Financial Interests, Personal, Advisory Role: Eisai; Other, Personal, Other, Chair this UK research group: NCRI CSG LORD subgroup. A.R. Minchom: Financial Interests, Personal, Advisory Board: Janssen Pharmaceuticals, Merck Pharmaceuticals, Takeda Pharmaceuticals, 4D Pharma , Genmab Pharmaceuticals; Financial Interests, Personal, Other, Honoraria: Chugai Pharmaceuticals, Novartis Oncology, Faron Pharmaceuticals, Bayer Pharmaceuticals, Merck Pharmaceuticals, GSK, Janssen Pharmaceuticals; Financial Interests, Personal, Other, Expenses: Amgen Pharmaceuticals; Financial Interests, Personal, Invited Speaker, Expenses: LOXO Oncology. L.M. Pickering: Financial Interests, Personal, Invited Speaker, Recorded teaching July 2020: BMS; Financial Interests, Personal, Invited Speaker, Group teaching, London, Dec 2019: BMS; Financial Interests, Personal, Advisory Board, Virtual, Oct 2020: BMS; Financial Interests, Personal, Invited Speaker, Virtual teaching to Eisai internal team, July 20: Eisai; Financial Interests, Personal, Advisory Board, Regional Advisory Board, Vienna, Nov 19: MSD; Financial Interests, Personal, Advisory Board, Regional Advisory Board, Munich, Apr 19: MSD; Financial Interests, Personal, Advisory Board, March 2019, London: Novartis; Financial Interests, Personal, Advisory Board, Virtual, Oct 20: Pfizer; Financial Interests, Personal, Invited Speaker, Virtual, Aug 20: Pfizer; Financial Interests, Personal, Invited Speaker, Budapest, Nov 19: Pfizer; Financial Interests, Personal, Advisory Board, London, Oct 19: Pfizer; Financial Interests, Institutional, Funding, Uncommon theme pump priming funds: NIHR; Financial Interests, Institutional, Funding, Tracking renal cancer evolution in blood: Rosetrees Trust; Other, Personal, Other, Charitable funding to support research students and internal departmental clinical research: Kidney and melanoma cancer fund of RMH charity. A. Furness: Financial Interests, Personal, Invited Speaker, Speaker fees: Bristol Myers Squibb, Ipsen, Eisai; Financial Interests, Personal, Advisory Board, Advisory Board: Immuncore; Non-Financial Interests, Personal, Advisory Role: Erase Mesothelioma. S. Turajlic: Financial Interests, Personal, Invited Speaker: IDEA Pharma, Roche, Ventana, MSD, Merck; Financial Interests, Institutional, Funding, Uncommon theme pump priming funds: NIHR; Financial Interests, Institutional, Funding, Digital theme funding: RMH/ICR/BRC/Imperial AHSC/Faculty of Medicine; Financial Interests, Institutional, Funding, Tracking renal cancer evolution in blood: Rosetrees Trust; Financial Interests, Institutional, Funding, Clinical PhD Fellowship over 3 years: CRUK Welcome Trust; Financial Interests, Institutional, Funding, Investigating the relationship between primary melanomas and their metastases: The Robert McAlpine Foundation; Financial Interests, Institutional, Funding, Innovation Grant Award for biomarker development: The Francis Crick Institute; Financial Interests, Institutional, Funding, Developing a novel method of representative tumour in sampling in clinical setting: Ventana; Financial Interests, Institutional, Funding, Mapping clonal evolution in renal cell carcinoma: CRUK training and career development board - clinician scientist fellowship; Financial Interests, Institutional, Funding: Harry J Lloyd Charitable Trust Career Development Award; Financial Interests, Institutional, Funding, Clinical Research Fellowship in melanoma: Andy Quick Charitable fund; Financial Interests, Institutional, Funding, Mechanisms of BRAF resistance: Complete Genomics; Financial Interests, Institutional, Funding, Molecular profiling of non-cutaneous melanoma: CRUK; Financial Interests, Institutional, Funding, Target discovery in acral melanoma: Rosetrees Trust. J. Larkin: Financial Interests, Personal, Invited Speaker: BMS, Pfizer, Roche, Pierre Fabre, AstraZeneca, Novartis, EUSA Pharma, MSD, Merck, GSK, Ipsen, Aptitude, Eisai, Calithera, Ultimovacs, Seagen, Goldman Sachs, eCancer, Inselgruppe, Agence Unik; Financial Interests, Personal, Other, Consultancy: Incyte, iOnctura, Apple Tree, Merck, BMS, Eisai, Debipharm; Financial Interests, Personal, Other, Honorarium: touchIME, touchEXPERTS, VJOncology, RGCP, Cambridge Healthcare Research, Royal College of Physicians; Financial Interests, Institutional, Funding: BMS, MSD, Novartis, Pfizer, Achilles, Roche, Nektar, Covance, Immunocore, Pharmacyclics, Aveo. K. Young: Non-Financial Interests, Personal, Principal Investigator, PI at RMH for Ultimovacs clinical trial: Ultimovacs. All other authors have declared no conflicts of interest.