1148PD - Immunotherapy in patients with concurrent solid organ transplant, HIV, and Hepatitis B and C

Date 11 September 2017
Event ESMO 2017 Congress
Session Immunotherapy of cancer
Topics Cancer in Adolescents
Hepatobiliary Cancers
Cancer Immunology and Immunotherapy
Cancer in Special Situations
Presenter Rajat Rai
Citation Annals of Oncology (2017) 28 (suppl_5): v403-v427. 10.1093/annonc/mdx376
Authors R. Rai1, O.M. Ezeoke2, J.L. McQuade3, L. Zimmer4, C. Koo5, J.J. Park6, L. Ardolino7, D. Yip8, S. Goldinger9, J.V. Cohen10, M. Millward11, V. Atkinson12, A.Y. Kane13, P.A. Ascierto14, C. Garbe15, R. Gutzmer16, D.B. Johnson17, M.D. Hellman18, G.V. Long19, A.M. Menzies19
  • 1Melanoma Oncology, Melanoma Institute Australia, The University of Sydney, 2060 - Sydney/AU
  • 2Department Of Medicine, Memorial Sloan Kettering Cancer Center, 10065 - New York/US
  • 3Department Of Medicine, MD Anderson Cancer Center, 77030 - Houston/US
  • 4Department Of Dermatology, University Hospital, University Duisburg-Essen, 47057 - Duisburg/DE
  • 5Department Of Oncology, Peter MacCallum Cancer Care Centre, 3000 - melbourne/AU
  • 6Department Of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, 2145 - Westmead/AU
  • 7Medical Oncology, Saint Vincent's Hospital, 2010 - Sydney/AU
  • 8Department Of Medical Oncology, The Canberra Hospital, 2605 - Garran/AU
  • 9Department Of Dermatology, University Hospital Zürich-Dermatology, 8091 - Zürich/CH
  • 10Department Of Oncology, Massachusetts General Hospital, 2114 - Boston/US
  • 11Department Of Medical Oncology, School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, 6009 - Nedlands/AU
  • 12Department Of Medical Oncology, Princess Alexandra Hospital, 4102 - Woolloongabba/AU
  • 13Department Of Immunology, Liverpool Hospital and Garvan Institute of Medical Research, Sydney/AU
  • 14Melanoma, Cancer Immunotherapy And Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione Pascale, 80131 - Napoli/IT
  • 15Department Of Dermatology, University of Tuebingen-Dermatology, 72076 - Tübingen/DE
  • 16Department Of Dermatology, Hannover Medical School, Klinik für Dermatologie, Allergologie und Venerologie, 30449 - Hannover/DE
  • 17Medical Oncology, Vanderbilt Ingram Cancer Center, 37232 - Nashville/US
  • 18Department Of Oncology, Memorial Sloan-Kettering Cancer Center, 10065 - New York/US
  • 19Melanoma Medical Oncology, Melanoma Institute Australia (MIA) and Royal North Shore Hospital, The University of Sydney, Sydney/AU

Abstract

Background

Anti PD-1/L1 (PD1) agents are being used to treat various tumor types. Most trials have excluded patients (pts) who have had a solid organ transplant (SOT), HIV, or Hepatitis (Hep) B and Hepatitis C. The safety and efficacy of PD1 in this setting is unknown.

Methods

Pts treated at 16 centres that had a transplant, HIV, Hep B/C were included. Patient demographics, tumour characteristics, toxicity, response and survival data, and the effect on the underlying condition were collected.

Results

42 pts were identified; 29 with melanoma, 6 bladder carcinoma (BC), 2 hepatocellular carcinoma (HCC), 2 renal cell carcinoma (RCC), 2 mesothelioma (meso), and 1 each of gastric carcinoma, glioblastoma multiforme (GBM) and non-small cell lung cancer (NSCLC). 5 pts with SOT (4 renal,1 liver) had melanoma received pembrolizumab; 3 had progressive disease (PD), 1 partial response (PR), and the pt with liver transplant had graft rejection and died from this after 1 dose. 11 pts had HIV; 2 with detectable viral load. 8 pts had pembrolizumab (7 melanoma, 1 HCC), 2 nivolumab (1 melanoma, 1 RCC) and 1 atezolizumab (BC). No pt had loss in viral control or immune reconstitution inflammatory syndrome. 2 had complete response (CR), 1 PR, 4 stable disease (SD) and 4 PD. 14 pts had Hep C; 9 with detectable viral load, 6 on anti-viral therapy and 5 with cirrhosis. 6 received pembrolizumab (5 melanoma, 1 meso), 7 nivolumab (4 melanoma, 1 each of NSCLC, BC, RCC) and 1 atezolizumab (BC). No pt had loss in viral control, 1 developed grade 3 colitis but no one developed hepatitis. 2 had CR, 9 SD and 3 PD. 12 pts with Hep B; 8 with detectable viral load, 6 on anti-viral therapy and none with cirrhosis. 8 had pembrolizumab (5 melanoma, 1 each of GBM, gastric carcinoma and meso), 4 nivolumab (2 melanoma, 1 BC, 1 HCC). No pt had loss in viral control.1 had CR, 1 PR, 8 SD and 2 PD. None of Hep B or Hep C pts developed immune related hepatits.

Conclusions

Immunotherapy appears to have activity in patients with SOT, HIV and Hep B and Hep C. It can be given to renal transplant pts without rejection, however this is not universal . PD1 does not appear to adversely affect the viral control in HIV and Hep B and Hep C pts.

Clinical trial identification

Not applicable

Legal entity responsible for the study

Human ethics approved protocol at Melanoma Institute Australia

Funding

None

Disclosure

L. Zimmer: Honoraria: Roche. S. Goldinger: Research funding from the Zurich University Hospital and received travel grant support from Novartis, Roche, MSD and Bristol-Myers Squibb. An intermittent advisory board relationship with Novartis, Roche, MSD and Bristol-Myers Squibb. M. Millward: grant support from GlaxoSmithKline during the conduct of the study and other support from GlaxoSmithKiline. V. Atkinson: advisory boards and received travel support and speaker\'s fees from Bristol-Myers Squibb, Novartis and MSD. GVL is a consultant advisor to Amgen, Merck MSD, Novartis and Roche received honoraria from Bristol-Myers Squibb, Novartis and Merck MSD. P.A. Ascierto: receiving consulting fees from Bristol-Myers Squibb, Roche, GSK, MSD, Ventana Medical Systems, Novartis, and Amgen, honoraria from Bristol-Myers Squibb, Roche, and GSK, and grant support to his institution from Bristol-Myers Squibb, Roche, and Ventana Medical Systems; C. Garbe: Advisory board: AMGEN, Bristol-Myers Squibb, GSK, MSD, Novartis and Roche Lecture honorarium: Bristol-Myers Squibb, MSD Consulting: Roche. R. Gutzmer: Received project support from Novartis Pharma and Pfizer Lecture honoraria from Novartis Pharma and Pfizer. D.B. Johnson: personal fees from Genoptix and Bristol-Myers Squibb. G.V. Long: personal fees from GlaxoSmithKline during the conduct of the study and personal fees from Roche, Novartis, Amgen, and Bristol Myers Squibb. A.M. Menzies: honoraria from Bristol-Myers Squibb and Novartis, and has sat on advisory boards for MSD and Chugai All other authors have declared no conflicts of interest.