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Poster display session

3279 - Impact of prior immune checkpoint inhibitors on haematological toxicity in Phase I patients receiving chemotherapy

Date

10 Sep 2017

Session

Poster display session

Topics

Cancers in Adolescents and Young Adults (AYA);  Supportive Care and Symptom Management;  Immunotherapy

Presenters

Alvaro Ingles Garces

Citation

Annals of Oncology (2017) 28 (suppl_5): v403-v427. 10.1093/annonc/mdx376

Authors

A.H. Ingles Garces1, J.E. Ang1, M. Ameratunga1, M. Chenard-Poirier1, D. Dolling2, R. Sundar1, S. Kaye1, J. de Bono1, U. Banerji1, J. Lopez1

Author affiliations

  • 1 Drug Development Unit, The Royal Marsden NHS Foundation Trust, SM2 5PT - London/GB
  • 2 Oncology, Institute of Cancer Research Royal Marsden Hospital, SM2 5PT - Sutton/GB
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Resources

Abstract 3279

Background

Immune checkpoint inhibitors (ICI) are used increasingly and earlier to treat multiple cancers. Although rates of on-treatment myelotoxicity are low, there are no published data on the long-term effects of ICI. This is a pilot study to evaluate the impact of prior ICI exposure on chemotherapy-related myelotoxicity in patients in the Phase I setting.

Methods

We conducted a retrospective chart review of patients treated between 2012 and 2016 in the Drug Development Unit, The Royal Marsden Hospital. Multivariate logistic regression (including number of previous treatment lines and type of chemotherapy) was used to assess possible relationships between G3/4 neutropenia or thrombocytopenia and previous treatment with immunotherapy in patients receiving combination chemotherapy and targeted agents.

Results

We identified 99 patients (median age 62 years [range 34-79]; chemotherapy partners: cisplatin, carboplatin and paclitaxel). Fourteen patients (14%) received prior immunotherapy (PI) and 85 (86%) had no prior immunotherapy (NPI). Patient characteristics, including baseline full blood count, previous pelvic radiotherapy, sites of metastasis and serum albumin, were comparable between the 2 groups, apart from number of previous treatment lines, which was lower in the PI patients (median 1.5 vs 2, p = 0.003). The odds of G4 neutropenia were higher in the PI group (OR = 7.1, 95% CI = 1.7-29.6, p = 0.007). PI was associated with significantly increased odds of G3/4 thrombocytopenia (OR = 14.4, 95% CI = 2.7-77.4, p = 0.002) on chemotherapy. In multivariate analysis, incorporating lines of prior chemotherapy (OR 1.3, 95% CI = 1.0-1.5, p = 0.037) and type of chemotherapy (carboplatin vs others: OR 2.3, 95% CI = 0.9-6.2, p = 0.094), the odds of developing G3/4 myelotoxicity were significantly higher in PI patients (OR 4.3, 95% CI: 1.3-14.4, p = 0.02).

Conclusions

In our small cohort, previous treatment with immunotherapy was associated with the development of G3/4 myelotoxicity, especially thrombocytopenia, on subsequent chemotherapy. These preliminary data require further prospective validation but may impact on decision making regarding optimal sequencing of systemic therapy.

Clinical trial identification

Legal entity responsible for the study

The Royal Marsden Hospital NHS Foundation Trust

Funding

None

Disclosure

J. de Bono: Consulting or advisory role: Astex, AstraZeneca, Genentech, Genmab, GSK, Merck, Pfizer, Sanofix Research Funding: AstraZeneca, Genentech, GSK, Sanofi, Janssen. U. Banerji: Receipt of grants/research supports: AstraZeneca, Chugai, Onyx, BTG Receipt of honoraria or consultation fees: Astex, Karus Therapeutics, Novartis, Vernalis. All other authors have declared no conflicts of interest.

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