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外文期刊>Journal for ImmunoTherapy of Cancer
>654?Real world incidence of grade III and higher adverse effects, emergency room utilization and hospital admissions during treatment with commonly used PD-1/PDL-1 targeting immune check point inhibitors
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654?Real world incidence of grade III and higher adverse effects, emergency room utilization and hospital admissions during treatment with commonly used PD-1/PDL-1 targeting immune check point inhibitors
Background The landscape of cancer treatment has changed drastically since the development of Immune Checkpoint Inhibitors (ICI). ICIs have become the cornerstone to various cancer treatments. 1 2 The adverse effect (AE) profile of ICI is different than conventional chemotherapy. Nivolumab and pembrolizumab target programmed cell death-1 T-cell receptor, whereas programmed death ligand-1 is targeted by atezolizumab and durvalumab. 3 4 Easy tolerability and lack of myelosuppresion make immunotherapy an attractive treatment option. Some AEs can be severe, life-threatening, or even fatal (grade III and higher). 1 Much of the data regarding AE profile is from clinical trials. The aim of our study is to review real world single institution AE data on the most commonly utilized ICIs. Methods We reviewed a total of 229 patient charts who had received pembrolizumab, nivolumab, durvalumab or atezolizumab at Saint Francis Hospital in Hartford, CT, USA. 53 patients were excluded given lack of records or because they received less than 2 cycles of treatment. Results 176 patients were included in the final analysis. ICIs were discontinued in 25/176 (14.2%) patients secondary to AE. 24/176 (13.6%) patients had grade III or higher AEs reported. 10/95 (10.5%) patients who received pembrolizumab developed grade III/IV AEs (8 pneumonitis, 2 nephritis). 5/45 (11.1%) patients treated with nivolumab developed grade III/IV AEs (2 pneumonitis, 1 new-onset DKA, 1 nephritis, 1 myositis). 8/19 (42.1%) receiving durvalumab had grade III or higher AEs (6 pneumonitis, 1 sepsis, 1 colitis). Lastly, 1/17 (5.8%) in atezolizumab group developed grade III/IV AE (colitis). 96/176 (54.5%) patients had one or more ER visit and 91/176 (51.7%) were admitted to the hospital for various reasons one or more times. Conclusions ICIs have a relatively safe drug profile. 86.4% of our studied population did not develop any grade III or higher AEs. The main reason for ICI discontinuation was disease progression rather than AE. The most common grade III/IV AE was pneumonitis. Durvalumab had the highest incidence of AE, pneumonitis, which is likely related to radiation use prior to immunotherapy.
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机译：背景，癌症治疗的景观大大变化，自免疫检查点抑制剂（ICI）的发育。 ICIS已成为各种癌症治疗的基石。 1 2 ICI的不良反应（AE）轮廓与常规化疗不同。 Nivolumab和Pembrolizumab靶编程细胞死亡-1 T细胞受体，而编程死亡配体-1是atezolizumab和durvalumab的靶向。 3 4易耐受性和缺乏髓鞘，使免疫治疗具有吸引力的治疗选择。一些AES可能是严重的，危及生命，甚至致命（III级和更高级）。 1关于AE概况的大部分数据来自临床试验。我们的研究目的是在最常用的ICIS上审查现实世界单一机构AE数据。方法，我们共审查了229名患者图表，曾在美国CT，CT，美国哈特福德的圣弗朗西斯医院接受过彭兰司布，Nivolumab，Durvalumab或atezolizumab。除了缺乏记录的情况下，53名患者被排除在外，或者因为它们收到不到2个循环的治疗。结果176例患者含有最终分析。 ICIS于25/176（14.2％）患者中患者中丧失。 24/176（13.6％）患者患有II级或更高的AES报告。 10/95（10.5％）接受Pembrolizumab的患者发育III级/ IV AES（8肺炎，2例，2个肾炎）。 5/45（11.1％）患有Nivolumab的患者，发育III级/ IV AES（2肺炎，1个新发病DKA，1个肾炎，1个肌炎）。 8/19（42.1％）接受Durvalumab具有III级或更高的AES（6个肺炎，1个脓毒症，1个结肠炎）。最后，atezolizumab组1/17（5.8％）开发了III级/ IV AE（结肠炎）。 96/176（54.5％）患者有一个或多个ER访问，91/176（51.7％）被视为一定或多次各种原因的医院。结论ICIS具有相对安全的药物概况。我们学习人口的86.4％没有发展任何III级或更高的AES。 ICI停止的主要原因是疾病进展而不是AE。最常见的III级/ IV AE是肺炎。 Durvalumab具有最高的AE发病率，肺炎可能与免疫疗法之前的辐射使用有关。
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