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Cancer outcomes in patients requiring immunosuppression in addition to corticosteroids for immune-related adverse events after immune checkpoint inhibitor therapy.

Authors
  • Burdett, Nikki1
  • Hsu, Kristin2
  • Xiong, Libo3
  • Tapia-Rico, Gonzalo1
  • Beckmann, Kerri4
  • Karapetis, Christos2, 5
  • Brown, Michael P1, 3, 6
  • 1 Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia. , (Australia)
  • 2 Flinders Medical Centre, Bedford Park, South Australia, Australia. , (Australia)
  • 3 School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. , (Australia)
  • 4 School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. , (Australia)
  • 5 Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia. , (Australia)
  • 6 Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, South Australia, Australia. , (Australia)
Type
Published Article
Journal
Asia-Pacific journal of clinical oncology
Publication Date
Apr 01, 2020
Volume
16
Issue
2
Identifiers
DOI: 10.1111/ajco.13177
PMID: 31215775
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To examine the cancer-specific outcomes for patients who experience immune-related adverse events requiring immunosuppression beyond corticosteroids. We performed a retrospective case series of patients between January 1, 2009 and April 1, 2018, across three metropolitan hospitals in Adelaide, South Australia. Eligible patients were identified from pharmacy records. Patients with a solid organ malignancy had discontinued checkpoint inhibitor therapy due to toxicity, and required immunosuppression in addition to corticosteroids to treat any immune-related adverse event. From 3860 patient dispensation records of immunosuppressive medications, 19 eligible patients were identified. Eight received a CTLA-4 inhibitor, four a PD-1 inhibitor, five combination immunotherapy, and two remained blinded. Sixteen patients had melanoma and three had non-small cell lung cancer. Median time to treatment failure was 8.7 months, and median overall survival was 9.4 months. Of those evaluable, the objective response rate was 35%, while 53% had progressive disease. Four patients died due to complications of their irAE, while six died from progressive disease. Patients who received immunosuppression for checkpoint inhibitor therapy toxicity had variable outcomes. This in part reflects a heterogeneous population, and the evolution of irAE management over time. Several patients continued to derive a benefit after cessation of therapy despite the use of immunosuppressive medications; conversely, four died as a direct consequence of their irAE. Physicians should promptly introduce immunosuppressive therapy in patients not responding to corticosteroids to mitigate the risk of life-threatening adverse events, given that current evidence does not clearly demonstrate a detriment to cancer-specific outcomes. © 2019 John Wiley & Sons Australia, Ltd.

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