1850P - Management and potential factors of immunotoxicity in patients with metastatic non-small cell lung cancer receiving first-line treatment with immune checkpoint inhibitors

Background

Immune checkpoint inhibitors (ICI) have changed the paradigm of non-small cell lung cancer (NSCLC) treatment. They can produce immune-related adverse events (irAEs) that are complex to predict/diagnose/treat. Guidelines lack robust trial-based recommendations.

Methods

We retrospectively reviewed the medical records of patients (pt) with advanced NSCLC who received first line treatment (1L) with ICI-inclusive regimen from January 2018 to January 2024 at the Medical Oncology Service of La Paz University Hospital in Madrid, Spain.

Results

We included 307 pt. Possible irAEs occurred in 107 pt. A total of 144 possible irAEs (grade ≥3: 37) were recorded: cutaneous (33), pneumonitis (28), hepatitis (28), thyroid (18), arthritis (12), colitis (9), nephritis (6), myositis (4), myocarditis (2), myasthenia (1), aortitis (1), hypophysitis (1) and neutropenia (1). Steroids were administered in 63 pt (median maximum dose of 50mg prednisone and median duration of 10.3 weeks) and a second immunosuppressor in 7 pt. Due to irAEs, ICI was stopped in 34 pt, admission was required in 29 pt, and it was the cause of death in 4 pt. When stratified by irAEs incidence, steroid use due to irAEs was not associated with a change in progression-free (PFS) or overall survival. A binary logistic regression to predict irAEs was performed including age, sex, smoking, hypertension, autoimmune disease, diabetes, dyslipidemia, stage, histology, PDL1, steroid, antibiotic, proton pump inhibitor, (neo)adjuvant therapy, hemoglobin, eosinophil, platelet, albumin, neutrophil-lymphocyte ratio, prognostic nutritional index, 1L regimen and PFS. Significant prognostic factors are described in the table. Table: 1850P

Conclusions

In this real-life cohort of NSCLC pt treated with a 1L ICI-inclusive regimen, we observed a safety profile consistent with the findings reported in clinical trials. We also noted variables associated with the development of irAEs.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.