The outcome and toxicity profile of checkpoint inhibitor immunotherapy subsequent to high-dose IL-2 in the treatment of metastatic melanoma and renal cell carcinoma.

Authors

Stephanie Berg

Stephanie A. Berg

Loyola University Health Sysem, Maywood, IL

Stephanie A. Berg, Joseph I. Clark, Elizabeth Henry, Courtney Regan Wagner, Robert Charles Flanigan, Hanh P. Mai

Organizations

Loyola University Health Sysem, Maywood, IL, Loyola University Chicago Medical Center, Maywood, IL, Loyola University Medical Center, Maywood, IL, Loyola University Chicago Stritch School of Medicine, Maywood, IL, Loyola University Medical Center, Chicago, IL

Research Funding

Other

Background: Approved treatments for metastatic melanoma (MM) and metastatic renal cell carcinoma (mRCC) include targeted agents, high dose interleukin-2 (HD IL-2) and checkpoint inhibitors (CI). A subset of responders to HD-IL2 can achieve long term durable remissions (7-10%). Recently, data suggests that durable remissions are possible with CI. Thus, despite increased toxicity, first-line immunotherapy with HD-IL2 is a reasonable consideration in carefully selected patients with clear cell mRCC and MM followed by CI upon relapse. Our study explores the utility and safety of CI subsequent to HD-IL2 in patients (pts) in this population.Methods: We conducted a single institution retrospective analysis of pts with MM or mRCC who received HD-IL2 and subsequent CI from 2008-2017. Pts treated with prior targeted therapy were included. Statistical analysis was performed using Fischer's exact tests, log-rank test for KM analysis and non-parametric Wilcoxon Rank Sum tests to compare the groups. Results: We identified 34 unique pts (19 MM, 15 mRCC) from our pre-specified cohort. Pts were male (73%), Caucasian (88%), and median age=53. mRCC pts received more cancer related treatments than MM prior to CIs after HD-IL2 was given (2 vs. 1, p=0.002), had more total CI cycles administered (12 vs. 7, p=0.10) but less IL-2 doses than MM pts (20 vs. 24, p=0.26). mRCC pts tended to record higher HD-IL2 toxicity grade compared to MM pts (exact =0.04). 26% (9/34) of pts experienced a grade 2 or higher CI toxicity. Pts had higher HD IL-2 toxicities than CI toxicities during therapy but these two measures were not significantly correlated (r=0.07, p=0.73); furthermore, there was no survival difference between pts with reported grade 2 or higher CI toxicity compared to pts without any CI toxicity (p=0.14). Conclusions: Our study suggests that CI therapy after HD-IL2 is feasible and not associated with more frequent toxicity or less clinical efficacy in pts with MM or mRCC.

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Abstract Details

Meeting

2019 ASCO-SITC Clinical Immuno-Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Breast and Gynecologic Cancers,Developmental Therapeutics,Genitourinary Cancer,Head and Neck Cancer,Lung Cancer,Melanoma/Skin Cancers,Gastrointestinal Cancer,Combination Studies,Implications for Patients and Society,Miscellaneous Cancers,Hematologic Malignancies

Sub Track

Immune Checkpoints and Stimulatory Receptors

Citation

J Clin Oncol 37, 2019 (suppl 8; abstr 14)

DOI

10.1200/JCO.2019.37.8_suppl.14

Abstract #

14

Poster Bd #

A7

Abstract Disclosures