551P - Real-world incidence and outcomes of immune-related adverse events in NSCLC patients

Background

The use of immune checkpoint inhibitors (ICI) has transformed the management of non-small cell lung cancer (NSCLC). With improved cancer outcomes have come increased auto-immune toxicities, which could affect any organ system. We investigated the incidence and outcomes of immune-related adverse events (irAE) in a large cohort of NSCLC patients.

Methods

Medical records from a metropolitan cancer centre in the AUstralian Registry and biObank of thoRAcic cancers (AURORA) registry were reviewed. Kaplan Meier analysis was used for survival estimates. Risk factors were tested using Fishers Exact test and logistic regression. False discovery rate of 5% was used to correct for multiple testing.

Results

Between 2013-2021, 449 patients received ICI. The median age was 65 years, 61% were male. Most (91%) had an ECOG of 0-1, 68% had metastatic disease at diagnosis, and 70% had adenocarcinoma. ICI was given as first line treatment in 47% of patients, and 22% had curative intent therapy. irAE were identified in 106 patients (24%). Most frequent was pneumonitis in 34 patients (incidence 7.6%); followed by colitis in 21 (4.5%), acute kidney injury in 19 (4.2%), thyroid disorders in 14 (3.1%), hepatitis in 12 (2.7%), skin toxicity in eight (1.8%), myositis in four (0.9%) and cardiac disorders and hypoadrenalism in three (0.7%) each. Toxicities noted twice included: arthropathy, hypoadrenalism, encephalitis, blood dyscrasias, diabetes, and ocular toxicities. Diabetes, gastritis and enteritis were identified in one patient each. Nineteen (4.2%) patients had two toxicities, one patient recorded three toxicities and one had four. No relationship was found between irAE and ICI combination therapy, smoking, age, performance status, or sex. The rate of pneumonitis was higher in those with airways disease than in those without (OR 14.81, 95% CI 6.64-33.59, P<0.01). Median overall survival in those with irAE was 18.7 months, versus 9.2 months in those without (HR 0.54, 95%CI 0.42-0.70, P=<0.01).

Conclusions

In a real word cohort, immune-related toxicities were similar to those reported in the literature. The development of irAE was associated with improved survival.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

B. Solomon: Financial Interests, Institutional, Advisory Board: AstraZeneca, Novartis, Merck, Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Pfizer, AstraZeneca, Roche/Genentech; Financial Interests, Personal, Advisory Board: Amgen, Roche-Genentech, Eli Lilly, Takeda, Janssen; Financial Interests, Personal, Full or part-time Employment, Employed as a consultant Medical Oncologist at Peter MacCallum Cancer Centre: Peter MacCallum Cancer Centre; Financial Interests, Personal, Member of Board of Directors: Cancer Council of Victoria, Thoracic Oncology Group of Australasia; Financial Interests, Personal, Royalties: UpToDate; Financial Interests, Institutional, Steering Committee Member, Principal Investigator and Steering committee Chair: Roche/Genentech, Pfizer; Financial Interests, Institutional, Steering Committee Member: Novartis. M. Alexander: Financial Interests, Personal, Advisory Board: BMS/Pfizer. T. John: Financial Interests, Personal, Invited Speaker, Speaker tour Vietnam: AstraZeneca; Financial Interests, Personal, Invited Speaker, CTIO: Merck Sharp Dohme; Financial Interests, Personal, Advisory Board: BMS, AstraZeneca, Bayer, Specialised Therapeutics; Financial Interests, Institutional, Advisory Board: Roche, Novartis, Pfizer, Amgen, Takeda, PharmaMar; Financial Interests, Personal, Other, Speaker/Chair: ACE Oncology. All other authors have declared no conflicts of interest.