Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Patterns of Immunotherapy use and management of toxicities in a regional cancer centre (#299)

Khobe K Chandran 1 , Yamamah Y Idrees 1 , Chih-Chiang C Hu 1 , Stefanie S Aranza 1 , Stephen S Brown 1
  1. Medical Oncology , Ballarat Base Hospital , Ballarat , Victoria, Australia

Background:

Cancer immunotherapy has revolutionised survival outcomes in patients to the extent that it is now recognised as one of the major modalities of cancer treatment1. Traditionally, these agents were administered through clinical trials in metropolitan sites with multi-disciplinary support. The number of regional and rural patients treated with these agents has increased as medical oncologists become more comfortable with the adverse event profile.

Although immunotherapy generally has a favourable toxicity profile compared to chemotherapy, they can provoke life-threatening immune related adverse effects (irAEs) caused by an unregulated and hyperstimulated immune response1. Our aim was to study the patterns of utilisation of these immunotherapy agents and to determine the rates, management and outcomes of irAEs at Ballarat Health Services (BHS).

Methods:

This is a retrospective audit which included all patients who were commenced on anti-programmed death 1 receptor (PD-1), anti-programmed death-ligand 1 (PD-L1) monotherapy or in combination with anti-CTLA-4 from 2013 to 2018. Patient and disease characteristics, treatment response and irAEs were collected and compared.

Results:

There were 105 patients treated with either single or combination immunotherapy in BHS. Cancer types include solid organ (lung, gastric/ gastro-oesophageal junction, renal), skin (melanoma) and haematological (lymphoma) malignancies. Preliminary data showed the rates of grade 3/4 irAEs were higher in the combination immunotherapy group, thus requiring more bed days in hospital. Data would be finalised and presented at the meeting.

Conclusion:

We aim to demonstrate that regional cancer centre, such as BHS are capable of delivering immunotherapy to patients safely with comparable outcomes, however not without challenges. A significant number of our patients experienced irAEs and their management warrants a multidisciplinary approach. A high index of suspicion, access to medical oncologist on-call and local guidelines are required for early recognition and timely management of irAEs.

 

  1. Reference(s): [1] Hamilton B, Xu K, Honeyball F, Balakrishnar B, Zielinksi R: Patterns of immunotherapy use and management of toxicities in regional and tertiary settings. Intern Med J. 2019; https://doi.org/10.1111/imj.14235