Incidence and management of immune-related adverse events at a regional hospital-A review of 4 years of immunotherapy

Abstract

Background: Immune checkpoint inhibition has ushered in a new era of oncology over the past several years. As the accessibility of immunotherapy increases, its use in smaller centers has expanded.We examined the safety and viability of using immunotherapy in a regional hospital by analyzing the incidence and management of immunerelated adverse events (IRAEs) at our center over the past 4 years. Methods: We performed a retrospective analysis of all patients with solid organ malignancies receiving immunotherapy (with any checkpoint inhibitor) over a 4-year period at our institution. Clinical and demographic details, including tumor type, current immunotherapy, grade, type and treatment of IRAEs, were collected from paper and electronicmedical records. Descriptive statistics were performed. Results: Between January 2013 and February 2017, 76 patients with solid organ tumors received immunotherapy at our service. Mean age at commencement was 64.5years (range 38-81). Metastatic nonsmall cell lung cancer was the most common indication (42%), followed by metastatic melanoma (40.5%). Median duration of treatment was 5.3 months (range 0-33.5). Twenty-seven patients (34%) had at least one IRAE. The most commonwas rash/dermatitis (33%), followed by thyroid dysfunction (19%), hepatitis (15%), colitis (15%) and pneumonitis (11%). Most (56%) were grade 2; 34% were grade 1 and 10% were grade 3 (two pneumonitis, a hepatitis and amyositis). There were no grade 4 or 5 adverse events. Almost all treatment for IRAEs was consistent with manufacturer and published guidelines. Systemic corticosteroids were employed rapidly in all grade 2/3 IRAEs. Endocrine consultation was sought in all cases of hypophysitis and necessary cases of thyroid dysfunction. Eight patients discontinued treatment due to IRAEs. Conclusions: The use of checkpoint inhibitors in a regional oncological unit is a safe and viable practice, with immune-related toxicity profiles similar to published data and treatment being administered consistent with established guidelines.L617549527 <br />