Immune-related adverse events (irAE) in GU cancer patients receiving immune checkpoint inhibitors.

Authors

null

Peter Zang

USC Keck School of Medicine, Los Angeles, CA

Peter Zang , Alexandra Drakaki , Izak Faiena , Betty Chan , Denice Tsao-Wei , Susan G. Groshen , David I. Quinn , Tanya B. Dorff

Organizations

USC Keck School of Medicine, Los Angeles, CA, University of California Los Angeles, Los Angeles, CA, Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA, Keck School of Medicine of USC, Los Angeles, CA

Research Funding

Other

Background: Immune checkpoint inhibitors (ICI), particularly PD-1 and PD-L1 antibodies, prolong survival in advanced renal cell (RCC) and urothelial cancer (UC) patients. However, they can cause a variety of serious irAE. We assessed frequency and onset of irAE at experienced centers, and evaluated whether baseline characteristics were associated with irAE. Methods: Pharmacy and clinic schedules identified RCC and UC patients treated with ICI at USC Norris (n = 51) and UCLA (n = 26) from 2014-2016. Prior radiation was defined as completion within 3 months before ICI. Fisher’s exact 2-tailed test was used to evaluate for associations of variables with irAE. Results: 77 patients median age 69 years (49-93) received ICI, 31 with RCC and 46 with UC; 36 received atezolizumab, 29 nivolumab, 9 pembrolizumab, 2 durvalumab, and 1 avelumab. 25 (32.5%) had irAE including pneumonitis (4%), myositis (3%), neurologic event (1%), hepatitis (8%), colitis (1%), rash (8%), endocrinopathy (6%), or hematologic event (1%). 11 (14%) required steroids, 3 (4%) required more intense immunosuppression (infliximab), 1 died of complications from irAE (pneumonitis). 5 were rechallenged with ICI after irAE resolution. Median time to onset of irAEs was 15 weeks; earliest onset of irAE (non-dermatologic) was 3 days after 1st dose, latest onset was 112 weeks. Associations of irAE with variables are listed in the table. Conclusions: irAE were more common in our experience than in published datasets, especially endocrine events, and could occur after the first dose. There was an association between irAE and allergy to antibiotics as well as external beam radiation therapy (EBRT) within 3 months before ICI therapy.

irAE n = 25no irAE n = 52p value
Gender1.0
Male19 (76%)38 (73%)
Female6 (24%)14 (27%)
Ethnicity0.69
White15 (60%)30(58%)
Asian/Pacific Islander5 (20%)13 (25%)
Hispanic/Latino5 (20%)7 (13%)
Dosage0.23
Low ( < 2 mg/kg)5 (20%)8 (15%)
Medium (2-4 mg/kg)14 (56%)38 (73%)
High ( > 4 mg/kg)6 (24%)6 (12%)
Agent0.092
PD-1 Inhibitor9 (36%)30 (58%)
PD-L1 Inhibitor16 (64%)22 (42%)
Prior EBRT0.031
Yes3 (12%)0
No22 (88%)52 (100%)
Allergy to antibiotic0.049
Yes7 (28%)5 (10%)
No18 (72%)47(90%)

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Abstract Details

Meeting

2018 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Prostate Cancer, Urothelial Carcinoma, and Penile, Urethral, and Testicular Cancers

Track

Urothelial Carcinoma,Prostate Cancer,Penile, Urethral, and Testicular Cancers

Sub Track

Urothelial Carcinoma

Citation

J Clin Oncol 36, 2018 (suppl 6S; abstr 422)

DOI

10.1200/JCO.2018.36.6_suppl.422

Abstract #

422

Poster Bd #

F15

Abstract Disclosures

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