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Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

5948 - Use of Immune Checkpoint Inhibitors (CPI) in Patients with Cancer and Concomitant Myasthenia Gravis (MG)

Date

20 Oct 2018

Session

Poster display session: Biomarkers, Gynaecological cancers, Haematological malignancies, Immunotherapy of cancer, New diagnostic tools, NSCLC - early stage, locally advanced & metastatic, SCLC, Thoracic malignancies, Translational research

Topics

Targeted Therapy

Tumour Site

Presenters

Houssein Safa

Citation

Annals of Oncology (2018) 29 (suppl_8): viii400-viii441. 10.1093/annonc/mdy288

Authors

H. Safa1, N. Abdel-Wahab2, V.A. Trinh1, D.H. Johnson3, T.E. Rodgers1, M. Suarez-Almazor2, A. Diab1

Author affiliations

  • 1 Department Of Medical Oncology, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 2 Department Of Internal Medicine, Section Of Rheumatology & Clinical Immunology, MD Anderson Cancer Center, 77030-4095 - Houston/US
  • 3 Melanoma, MD Anderson Cancer Center, 77030-4095 - Houston/US
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Resources

Abstract 5948

Background

The safety of CPI in patients (pts) with autoimmune diseases was never fully assessed since they were always excluded from clinical trials for fear of unleashing the underlying autoimmunity, and susceptibility to severe immune-related adverse events (irAEs). Pts with MG require special consideration as they are known to have severe morbidities and might be susceptible to life-threatening complications.

Methods

We identified from pharmacy records pts who had received CPI between January 2004 and June 2017 at our institution (n = 4,406). Claims data were obtained for all pts from 6 months prior to first infusion to last follow-up or death. ICD 9 & 10 diagnostic codes were used to identify pts with MG. We systematically reviewed the literature databases through March 2018 to identify similar pts.

Results

A total of 39 pts were retrieved; 5 from institutional databases and 34 from literature. Median age was 73 (57-86) years; 56% male, 49% had metastatic melanoma and other cancer types. Most received anti-PD1/PD-L1 agents (79%). A prior diagnosis of MG was reported in 23%; most were maintained on corticosteroids, anticholinesterase, azathioprine, or mycophenolate mofetil, and only one had active disease symptoms at initiation of CPI. In the remaining 77%, MG manifested clinically only after initiation of CPI therapy. Overall, 38% developed respiratory failure requiring mechanical ventilation, including 8 pts who needed urgent intubation. MG symptoms occurred with other irAEs (myositis, myocarditis, polyneuropathy, and Guillain Barre Syndrome) in 15%. Most pts required treatment with high dose corticosteroids (90%), intravenous immunoglobulin (45%), and plasmapheresis (42%). Other treatments included azathioprine, mycophenolate mofetil, rituximab, or infliximab. Discontinuation of CPI was recommended in 87%. Most pts (81%) improved with treatment. In melanoma pts, 54% (7/13) achieved partial or complete response to CPI. In all pts, death was reported in 40%, primarily because of respiratory failure in 11%.

Conclusions

CPI seems to be associated with serious consequences and high rate of death in pts with MG. Further studies are needed to establish the risk-benefit profile in this population.

Clinical trial identification

Legal entity responsible for the study

UT MD Anderson Cancer Center.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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