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e-Poster Display Session

44P - The hematologic toxicities of chemo-immunotherapy compared to chemotherapy alone: A systematic review and meta-analysis

Date

09 Dec 2020

Session

e-Poster Display Session

Presenters

Daniel Eiger

Citation

Annals of Oncology (2020) 31 (suppl_7): S1428-S1440. 10.1016/annonc/annonc391

Authors

D. Eiger, E. Agostinetto, R. Caparica, M.A. Franzoi, M. Brandão

Author affiliations

  • Institut Jules Bordet, Brussels/BE
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Abstract 44P

Background

The association of immune checkpoint inhibitors (ICI) to chemotherapy (I-ChT) has been shown more efficacious than chemotherapy (ChT) alone for patients with various solid tumours, thus becoming a standard treatment option in several settings. There could be an additive effect between ChT-induced myelotoxicity and immune-mediated cytopenias due to ICI, although it is currently unknown if such a detrimental interaction occurs. Therefore, the aim of this meta-analysis is to address this question.

Methods

A systematic review using MEDLINE, Cochrane, and conference proceedings (manual selection of studies presented at major congresses) up to 5 June 2020, with restriction to English language, was performed. Randomized clinical trials comparing I-ChT vs. ChT in patients with solid tumours were selected. Main endpoints were all-grade (G) anemia, neutropenia, febrile neutropenia (FN) and thrombocytopenia. Other endpoints were the same cytopenias grouped by G (1-2, 3-4, and 5). Subgroup analyses according to class of ICI and a sensitivity analysis excluding trials with a different number of cycles of ChT between arms were done. Pooled odds ratios (pOR) and confidence intervals (CI) were calculated using random effects models.

Results

Overall, 19 publications (14 testing an anti-PD(L)1-based I-ChT and 5 an anti-CTLA4-based I-ChT) were included, with 5254 patients in the I-ChT arm and 4316 in the ChT arm. Pooled incidences per I-ChT and ChT arms of all-G anemia, neutropenia, FN, and thrombocytopenia were 42% vs. 38%, 33% vs. 30%, 7% vs. 5%, and 20% vs. 17%, respectively. There was neither a significant increase in the odds of all-G anemia (pOR=1.04; 95% CI=0.90-1.21; p=0.58), neutropenia (pOR=1.01; 95% CI=0.87-1.16; p=0.94), FN (pOR=1.24; 95% CI=0.97-1.58; p=0.09), and thrombocytopenia (pOR=1.14; 95% CI=1.00-1.30; p=0.06), nor by groups of G. An increment in the odds of all-G thrombocytopenia was found with anti-PD(L)1-based I-ChT vs. ChT (pOR=1.18; 95% CI=1.02-1.36; p=0.03). Results were similar in the sensitivity analysis.

Conclusions

Apart from a small increase in the odds of all-G thrombocytopenia with anti-PD(L)1-based I-ChT, I-ChT appears to be as safe as ChT in terms of hematological toxicities.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

D. Eiger: Research grant/Funding (self), Research grant/Funding (institution), Funding provided for his ESMO Fellowship (2018-2019): Novartis; Research grant/Funding (institution): Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier; Research grant/Funding (institution): Pfizer; Honoraria (self), Speaker Honoraria: Janssen. R. Caparica: Honoraria (self), Speaker Honoraria: Boehringer-Ingelheim; Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses, Speaker Honoraria: AstraZeneca; Honoraria (self), Speaker Honoraria: Janssen; Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Research grant/Funding (institution): Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution): GSJ/Novartis; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier,. M.A. Franzoi: Research grant/Funding (institution): Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution): GSJ/Novartis; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier. M. Brandão: Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution): GSJ/Novartis; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier; Research grant/Funding (institution): Pfizer. L. Buisseret: Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution): GSJ/Novartis; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier; Research grant/Funding (institution): Pfizer; Honoraria (self), Speaker Honoraria: BMS. A. de Caluwé: Research grant/Funding (institution): Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution): GSJ/Novartis; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier; Research grant/Funding (institution): Pfizer. D. Gimenes: Honoraria (self), Speaker Honoraria: Novartis; Honoraria (self), Speaker Honoraria: Pfizer; Honoraria (self), Speaker Honoraria: United Medical. N.F. Pondé: Travel/Accommodation/Expenses: Roche/GNE; Travel/Accommodation/Expenses: Janssen-Cilag; Honoraria (self), Travel/Accommodation/Expenses, Speaker Honoraria: Mundipharma. E. de Azambuja: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche/GNE; Research grant/Funding (institution): Radius; Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Lilly; Research grant/Funding (institution): MSD; Research grant/Funding (institution), Travel/Accommodation/Expenses: GSJ/Novartis; Research grant/Funding (institution): Synthon; Research grant/Funding (institution): Servier; Research grant/Funding (institution): Pfizer. All other authors have declared no conflicts of interest.

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