Clinical characteristics of adrenal insufficiency as an immune-related adverse event in non-small-cell lung cancer

Nivolumab is an immune checkpoint inhibitor that is used to treat various advanced cancers, including metastatic non-small cell lung cancer (NSCLC). Nivolumab treatment has different side effects. For this patient with advanced NSCLC, pericardial effusion was considered to be an immune-related adverse event after immunotherapy. It was characterized by deterioration of symptoms and considered to be pseudo-progression. The pericardial effusion gradually disappeared as nivolumab treatment continued during intensive follow-up monitoring. After chemotherapy and disease progression, the patient was treated with oral targeted therapy based on genes that were detected. After the re-imaging to assess the targeted therapy progress, immunotherapy was used. During immunotherapy, the patient showed increased pericardial effusion, and he underwent one pericardial puncture, in which 200 mL of pericardial effusion was drained. The pericardial effusion after puncture was not diagnosed as malignant by pathology, and the pericardial effusion remained. Shortness of breath continually improved during immunotherapy, and immunotherapy was continued with close observation. After 11 cycles, pericardial effusion had resolved. This case suggested that NSCLC pericardial effusion that was caused by an immune-related adverse event after immunotherapy might be considered to be pseudo-progression.

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Myocarditis as a rare, yet serious adverse event associated with immune checkpoint inhibitors in patients with non-small cell lung cancer: Case series from a large community-based cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21047 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21047-e21047

Author(s):

Mohamed Hendawi ◽

Luke Peterson ◽

Eyob ale Tadesse ◽

Frank M. Wolf ◽

Thomas D. Brown ◽

...

Keyword(s):

Lung Cancer ◽

Adverse Event ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Small Cell ◽

Small Cell Lung ◽

Serious Adverse Event

e21047 Background: Patients (pts) with lung cancer and other cancers treated with immune checkpoint inhibitors (ICI) may experience immune related adverse events (irAE). These can present with variable severity and with single- or multi-organ involvement including pneumonitis, colitis, hepatitis, and myocarditis/pericarditis. The incidence of myocarditis has been reported between 0.06% and 2.4% and is associated with a high mortality (25% to 50%). This retrospective review of real-world data (RWD) investigates myocarditis as a high-grade adverse event in pts with lung cancer treated with ICIs. Methods: Pts were identified and characterized using RWD in the Syapse Learning Health Network platform from 2010 to 2020 at Advocate Aurora Health Care. Eligible pts included: ≥18 years old; histologically confirmed NSCLC; and myocarditis diagnosis by ICD codes. Additional chart review was performed to confirm timing of ICI treatment and myocarditis. All pts identification and review were performed after IRB review. Results: 12,686 pts with non-small cell lung cancer were eligible for review. The median age at diagnosis was 70; 54% were female; 86% were White and 12% were Black; 1,975 (15.6%) were treated with an ICI and of those 4 cases (0.2%) of myocarditis were identified. All 4 pts were White females, ages 46, 59, 65, and 74 years. Pathology included lung adenocarcinoma (3) and an undifferentiated lung carcinoma (1). All pts had metastatic disease, and none had a prior history of cardiac disease. ICIs were pembrolizumab (2), durvalumab (1), and nivolumab (1). Median time from initial dose of ICI to diagnosis of myocarditis was 62 days [range: 42-185]. All 4 pts presented with chest pain and elevated troponin T [median 0.07 ng/ml (range: 0.06-0.08)]. All pts had echocardiography at the time of diagnosis, and 2 pts had cardiac MRI that confirmed myocarditis. 3 pts were treated with a prednisone taper. 1 pt died of recurrent congestive heart failure and ventricular tachycardia despite rescue attempt with high dose corticosteroids. 2 pts had additional concomitant irAEs of hypothyroidism/colitis, and thyroiditis/pneumonitis, respectively. Conclusions: Many irAEs are reversible. This RWD analysis confirms that clinically evident myocarditis is a rare but serious adverse event of ICI therapy. Early consideration, diagnosis, and intervention may help prevent poor outcomes. Termination of ICI therapy along with initiation of corticosteroids constitute the current standard of management. Further research is warranted to better identify high risk groups, surveillance measures, and improved management of ICI associated myocarditis.

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P45.16 Adverse Event Burden of Oral Tyrosine Kinase Inhibitors in EGFR and ALK Metastatic Non-Small Cell Lung Cancer

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.08.484 ◽

2021 ◽

Vol 16 (10) ◽

pp. S1092

Author(s):

D. Riley ◽

N. Kaur ◽

A. Baglione ◽

R. Hall ◽

L. Barnes ◽

...

Keyword(s):

Lung Cancer ◽

Adverse Event ◽

Tyrosine Kinase ◽

Small Cell Lung Cancer ◽

Tyrosine Kinase Inhibitors ◽

Cell Lung Cancer ◽

Kinase Inhibitors ◽

Small Cell ◽

Small Cell Lung

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Real-world outcomes and clinical characteristics of patients with brain metastases from EGFR mutated non-small cell lung cancer: Data from a large retrospective study (REFLECT).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.9086 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 9086-9086

Author(s):

Urska Janzic ◽

Alfredo Addeo ◽

Elizabeth Dudnik ◽

Andriani Charpidou ◽

Adam Pluzanski ◽

...

Keyword(s):

Lung Cancer ◽

Data Collection ◽

Brain Metastases ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Real World ◽

Clinical Characteristics ◽

Small Cell ◽

Small Cell Lung ◽

Cancer Data

9086 Background: Brain metastases (BM) frequently occur in patients (pts) with epidermal growth factor receptor mutated non-small cell lung cancer (EGFRm NSCLC) and represent a poor prognostic marker. This study aimed to describe the clinical characteristics, treatment patterns and survival outcomes in EGFRm NSCLC pts treated with 1st or 2nd generation tyrosine-kinases inhibitors (TKIs) in first-line (1L). Methods: The retrospective real-world study REFLECT (NCT04031898) collected data from 896 pts initiating 1L TKI between 1 January 2015-30 June 2018 in Europe and Israel. Descriptive statistics were used to assess demographic and clinical characteristics in subgroups of patients with and without BM. Kaplan-Meier methods were used to estimate median real world progression free survival (mPFS) and overall survival (mOS) from start of 1L. Results: Out of 896 pts, 198 (22.1%) had BM at start of 1L, 134 (15%) developed BM later (any time), and 564 (62.9%) had no sign of BM at the time of data collection. Among pts who later developed BM the median time between the start of 1L and first diagnosis of BM was 13.5 months. Median duration of follow-up was 21.5 months. Of 332 pts with BM at any time 64.2% were female, similar to the ratio in pts without BM (64.0%). At diagnosis, median age was 65 years in pts with BM vs. 70 in those who never developed BM. Of pts with BM at any time, 50.9% had exon 19 deletion, 30.4% L858R point mutation and 18.7 % uncommon EGFR mutations at baseline, compared to 56.6%, 31.7% and 11.7% in pts without BM, respectively. At data collection, 94.9% of the pts with BM at diagnosis had progressed compared to 79.8% among those with no BM. Overall, whole brain radiation was the most frequently used treatment for BM (31.0%) followed by stereotactic radiosurgery (18.1%) and targeted therapies (13.3%). T790M testing rates were highest among pts developing BM later (85.7%) and lowest among those with BM from start (66.1%). The T790M positivity rate was highest in pts developing BM later (65.7%) and lowest among those with BM from start (50.4%). More pts received osimertinib in later lines among those with BM at any time compared to those without BM (51.3% vs 43.8%). Median real world PFS and OS (95% CI) were shorter among pts with BM at baseline compared to those never developing BM: 10.2 (8.8, 11.5) vs 15.2 (13.7, 16.1) months, and 19.4 (17.1, 22.1) vs 30.3 (27.1, 33.8) months, respectively. At the time of data collection, 77.3% of pts with BM at baseline were deceased compared to 52.5% pts with no BM. Conclusions: More than one third of pts included in REFLECT had BM at any time. Uncommon EGFR variants at baseline were observed more frequently in pts with BM. mPFS and mOS were shorter in pts with BM at baseline compared to those never developing BM. These data highlight the need for improved treatment and CNS control in pts with EGFRm NSCLC. Clinical trial information: NCT04031898.

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