Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2017 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Neurotoxicity associated with anti-PD1 therapy: A multi-center case series.
Symptom Management/Supportive Care/Palliative Care
Patient and Survivor Care
2017 ASCO Annual Meeting
J Clin Oncol 35, 2017 (suppl; abstr e21641)
Author(s): Jess Louise Smith, Alexander M. Menzies, Justine Vanessa Cohen, Margarida Mut Lioret, Alpaslan Ozgun, Lavinia Spain, John J. Park, Douglas Buckner Johnson, Jennifer Leigh McQuade, Sophie Feng, Shahneen Kaur Sandhu, Victoria Atkinson, Katy K. Tsai, Georgina V. Long, James M. G. Larkin, Zeynep Eroglu, Ryan J. Sullivan, Andrew Henderson, Matteo S. Carlino; Crown Princess Mary Cancer Centre Westmead, Sydney, Australia; Melanoma Institute Australia, Royal North Shore Hospital, The University of Sydney, Sydney, Australia; Yale Cancer Center, New Haven, CT; Peter MacCullum Cancer Cantre, Melbourne, Australia; Moffitt Cancer Center, Tampa, FL; Royal Marsden Hospital, London, United Kingdom; Westmead Hospital, Chatswood, Australia; Vanderbilt University Ingram Cancer Center, Nashville, TN; The University of Texas MD Anderson Cancer Center, Houston, TX; Princess Alexanda Hospital, Woolloongabba, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; University of Queensland, Brisbane, Australia; Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA; University of Sydney, Sydney, Australia; The Royal Marsden NHS Foundation Trust, London, United Kingdom; Massachusetts General Hospital, Boston, MA; Westmead Hospital, Westmead, Australia; Westmead and Blacktown Hospitals, Westmead, Australia
Background: The anti-PD1 antibodies (PD1) pembrolizumab and nivolumab are now FDA-approved in multiple malignancies. With increased use, rarer immune-related adverse events (irAEs) not well characterized in clinical trials are being identified, including neurotoxicities. Methods: Patients (Pts) who developed neurotoxicites while being treated with PD1 (alone or in combination) were retrospectively identified from 10 cancer centers. Data regarding treatment, toxicity and outcome were examined. Results: 40 pts (38 melanoma and 2 non-small cell lung cancer pts) developed neurotoxicity; 14 on anti-PD1 monotherapy, 23 in combination or sequence with ipilimumab, and 3 on blinded trials or in combination with interferon. The overall response rate was 90% and median progression free survival was not reached. The median time from treatment initiation to development of neurotoxicity was 7 weeks (range 1-86.5 weeks). 8 pts had died, 5 from disease progression and, 2 from neurotoxicity. 26 pts (65%) developed other irAEs. 27 (67.5%) pts developed toxicities affecting the peripheral nervous system including motor sensory neuropathies (6), sensory neuropathies (4), and Myasthenia Gravis (3). 13 (32.5%) pts developed central nervous system toxicities including aseptic meningitis (6) and encephalitis (4). 24 (60%) pts were treated with steroids alone. 9 pts required further immunomodulation including IVIG (7), plasmapheresis (3), MMF (1) and rituximab (1). 17 (43%) had complete resolution of symptoms, 5 (13%) had stable or worsening neurological disease, and 22 ( 55%) were improving at the time of datacut . 10 pts were retreated with PD1, of which 2 developed exacerbation of prior neurological symptoms. Conclusions: While rare, a variety of neurotoxicities can occur with PD1 treatment. Management may require immunomodulation beyond corticosteroids. Given the high response rate observed in this cohort, such toxicities and their management do not appear to negatively impact treatment response.
Meeting: 2017 ASCO Annual Meeting Abstract No: LBA10001 First Author: Gary Rodin
Meeting: 2017 ASCO Annual Meeting Abstract No: LBA10004 First Author: Peter Hoskin
Meeting: 2017 ASCO Annual Meeting Abstract No: 10005 First Author: Areej El-Jawahri