Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2018 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Impact of comorbidity on immune checkpoint blockade tolerance across tumor types.
Immune Checkpoint Inhibitors
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr e15068)
Author(s): Sean Clark-Garvey, Thomas Holden, Daniel S. Altman, Sheel A. Patel, Sharon Li, Reetu Mukherji, Philip Margiotta, Mario Caldararo, Marlana M. Orloff, Jennifer Maria Johnson, Ryan Michael Weight; Thomas Jefferson University, Philadelphia, PA; Thomas Jefferson University, Philadelphia, PA, US; Jefferson Medcl Coll, Bethesda, MD; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Thomas Jefferson University, Department of Medical Oncology, Philadelphia, PA
Background: Immune Checkpoint Blockade (ICB) has demonstrated efficacy across a variety of tumor types. However, treatment is often complicated by immune related adverse events (irAEs), leading to discontinuation of therapy. Patients with poor performance status are excluded from most clinical trials. Therefore, the effect of comorbid conditions on the development irAEs is unknown. We analyzed a large single institution registry to determine the correlation of comorbidity and discontinuation of ICB across tumor types. Methods: A single institution registry of 113 patients who received and discontinued ICB, (ipilimumab [n = 18], nivolumab [n = 33], pembrolizumab [n = 18], atezolizumab [n = 4]) was reviewed. Reasons for discontinuing ICB were analyzed by tumor type and immunotherapy agent. Tumor subtypes included: Melanoma (43), NSCLC (40), Bladder (9), and other (21). ECOG PS and Charleston Comorbidity Index (CCI) were independently analyzed and correlated with development of irAEs. Results: The most common cause for discontinuation across all tumors was POD (64.6%); while 18.6% discontinued due to irAEs. Interestingly, there was no statistically significant difference between the rate of treatment-limiting irAEs and ECOG PS (p = 0.12) or CCI (p = 0.99). Only 1 of 18 patients with an ECOG PS of 2-3 discontinued therapy due to an irAE. See Table 1 Conclusions: Pre-treatment comorbidity did not influence the discontinuation rate of immune checkpoint blockage due to irAEs. The low rate of therapy discontinuation in patients with poor performance status and high comorbidity index provides insight into the application of immune checkpoint blockage outside of a clinical trial.
|Reasons for Discontinuation|
|Progression of |
|Number of patients, n (%)||73 (64.6)||21 (18.6)||19 (16.8)|
|ECOG PS, n (%)|
|0||13 (46.4)||9 (32.1)||6 (21.5)|
|1||34 (64.2)||9 (17)||10 (18.8)|
|2-3||14 (77.8)||1 (5.6)||3 (16.6)|
|Treatment, n (%)|
|Nivolumab||33 (68.8)||5 (10.4)||10 (20.8)|
|Pembolizumab||18 (75)||2 (8.3)||4 (16.7)|
|Ipilumumab||18 (52.9)||14 (41.2)||2 (5.9)|
|Atezolizumab||4 (57.1)||0 (0)||3 (42.9)|
*Reported as the average value for all patients.