Background and importance Despite the clinical benefits of therapy with control point inhibitors in several malignancies, this inhibition is closely linked to a series of immune related adverse events (irAEs). The early detection and management of these is of vital importance.
Aim and objectives To identify and describe irAEs with programmed cell death protein 1 (PD-1) inhibitors and programmed death ligand 1 (PD-L1) inhibitors in clinical practice.
Material and methods A retrospective, descriptive, observational study was conducted in a 400 bed hospital in patients treated with immunotherapy (IT) from 1 January 2016 to 30 October 2018. Variables were age, gender, type of tumour, stage, IT, irAEs and grade, cycles until irAE appearance, irAE treatment and IT suspension. The electronic medical history was reviewed in OrionClinic and IT treatment in Farmis-Oncofarm. The causality of irAEs was ascertained on the basis of the European Society for Medical Oncology (ESMO) algorithms. Statistical analysis was performed with SPSS V.15.
Results A total of 127 patients were treated with an average age of 65 years (range 36–88) and 75% were women: 76% of patients had non-microcytic lung cancer, 7% head–neck, 6% bladder, 5% breast, 4% renal, 2% melanoma and colorectal cancer. In 67% of patients, stage IV tumours were found, in 27% stage III, in 4% stage II and in 2% stage I. Nivolumab was prescribed in 54% of patients, pembrolizumab in 26%, atezolizumab in 13% and durvalumab in 7%. Fifty-two irAEs were identified. The average number of cycles until irAE appearance was 3.25 (range 1–57). The main irAEs were cutaneous (37%), gastrointestinal (23%), pneumonitis (14%) and endocrinological (8%); 64% grade I, 25% grade II, 12% grade III and no grade IV. Treatment was given for 66% of irAEs: oral corticoids (52%), topical corticoids (17%), antihistamines (12%) and hormone replacement therapy (5%). IT was resumed in 83% of patients. By the end of the study period, 31% of patients remained on therapy. Non-continuity was due to progression (55%), irAEs (10%) and other reasons (4%).
Conclusion and relevance The most frequent irAEs in patients receiving IT were cutaneous and gastrointestinal, mostly transitory and grades I–II. They were mostly resolved with corticotherapy and antihistamines. Management of irAEs was presented on the basis of clinical experience; cooperation of patients, caregivers and healthcare professionals is required to watch over their safety to obtain the maximum efficacy with the lowest irAEs possible.
References and/or acknowledgements No conflict of interest.
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