CN91 - Toxicities in breast cancer patients undergoing neoadjuvant immune checkpoint inhibitor therapy: Insights from a nurse practitioner perspective

Background

Use of immune checkpoint inhibitors (ICI) in early breast cancer (EBC) has significantly impacted clinical outcomes. Still, associated toxicities present novel challenges in patient care, needing a multidisciplinary approach. Advanced Nurse Practitioners (ANPs) play a pivotal role in ensuring quality cancer care, focusing on enhancing quality of life and safety. We examine the impact of ICI toxicities and the role of ANPs within a real-world context.

Methods

Prospective registry-based cohort study including 42 EBC patients (pts) treated from 2023 at Hospital Clinic Barcelona. Patients were categorized in two cohorts based on treatment regime: ICIs & non-ICI neoadjuvant therapy. Baseline characteristics, subtype, stage, treatment, toxicities, and outpatients visit were recorded. Chi-square, Mann-Whitney U test and multivariable analysis tests were employed.

Results

Among the 42 pts, 25 (59.5%) received ICI, with no differences in age and comorbidities between groups. All pts in ICI group had triple-negative BC (p<0.001), and while no differences were observed regarding stage or use of dose-dense regimens, carboplatin was used in 24(96.0%) vs 5(29.4%) in ICI and non-ICI group, respectively (p<0.001). With no differences in dose reductions, yet significant increase of dose interruptions (p=0.002) was observed, along with a numerical rise in definitive interruptions (56.0% vs 35.2%, p=0.187) for ICI group. ICI group exhibited higher grade 3 toxicities (68.0% vs 11.8%; p<0.001), significant even after adjusting by carboplatin use, odds ratio 14.4 (p=0.026). 11(44.0%) pts reported immune related adverse events (irAE), 20% endocrinopathies, including 1 hypophysitis, and 1 pneumonitis. Finally, an increase in emergency visits and hospitalizations was seen in ICI group (p=0.019), with 52.9% needing 4 or more additional ANP outpatient visits (p=0.039).

Conclusions

This is ongoing study underscores the impact of toxicities among pts treated with ICI and the critical role of ANPs in optimizing their management. With an ever-growing use of ICI, training, and resources to equip ANPs with the necessary tools to manage adverse event is central to keep up with a patient-centered care in oncology.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

E. Segui Solis: Financial Interests, Personal, Invited Speaker: Novartis, Veracyte, Pfizer, Daiichi Sankyo, Eisai; Financial Interests, Personal, Advisory Board: Pfizer, Seagen; Financial Interests, Personal, Full or part-time Employment: Solti; Financial Interests, Personal, Research Grant: Amgen. F. Schettini: Financial Interests, Personal, Invited Speaker: Novartis, Gilead, Daiichi Sankyo; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Other, Travel expenses: Novartis, Gilead, Daiichi Sankyo. T. Pascual: Financial Interests, Personal, Invited Speaker: Pfizer, AstraZeneca, Veracyte, Novartis; Financial Interests, Personal, Advisory Board: Roche, Genentech, Novartis. M.J. Vidal Losada: Financial Interests, Personal, Advisory Board: Novartis Pfizer, Roche, Pfizer, AstraZeneca, Daiichi Sankyo; Financial Interests, Personal, Invited Speaker: Novartis, Pfizer, Roche, Genentech, AstraZeneca, Daiichi Sankyo, Gilead Sciences, Veracyte, Guardant Health; Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Pfizer; Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Gilead Sciences. A. Prat: Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker, Lecture fees: Novartis, Daiichi Sankyo; Financial Interests, Personal, Advisory Board, Advisory role/consultancy: Novartis, Pfizer, Peptomyc; Financial Interests, Institutional, Invited Speaker, Clinical trials: Daiichi Sankyo; Financial Interests, Institutional, Other, Contracted research: Boehringer, Medica Scientia Innovation Research; Financial Interests, Personal, Advisory Board: AstraZeneca, Reveal Genomics, 1TRIALSP, S.L.; Financial Interests, Personal, Member of Board of Directors, Leadership role: Reveal Genomics, SL.; Financial Interests, Personal, Stocks/Shares: Reveal Genomics; Financial Interests, Personal, Royalties: Reveal Genomics, International Oncology Bureau, S.L.,; Financial Interests, Institutional, Local PI: Roche, AstraZeneca; Financial Interests, Personal and Institutional, Steering Committee Member: Daiichi Sankyo; Financial Interests, Institutional, Coordinating PI: Novartis; Financial Interests, Institutional, Funding: Reveal Genomics; Non-Financial Interests, Institutional, Other, Leadership roles: Patronage Committee: Actitud Frente al Cáncer Foundation; Non-Financial Interests, Personal, Other, Asociación Española de Investigación sobre el Cáncer: ASEICA; Non-Financial Interests, Personal, Other, Research Foundation that gives grants to researchers: FERO. All other authors have declared no conflicts of interest.