MO362CHECK- POINT INHIBITORS AND THEIR KIDNEY INVOLVEMENT

Abstract Background and Aims Monotherapy immunotherapy with “check-point inhibitors” (anti PD-1, Anti PD-L1) is an effective therapy to advanced-stage cancer patients. Little is known about our experience and its renal implication, although it is related to fluid and electrolyte disorders or acute kidney failure (AKI). To evaluate changes in natremia or acute renal impairment (primary endpoints) in IV stage cancer patients with lung, bladder or melanoma neoplasm who have received monotherapy with pembrolizumab (PEM), atezolizumab (ATZ) or nivolumab (NIV). At the same time, analyze if there are differences between drug administered, underlying disease or having received cisplatin previously (secondary outcomes). Method single-center retrospective analysis. Inclusion period: January 2015 to September 2020. Dose administered: PEM 2mcg/kg/21 days; ATZ 1200mg/21 days; NIV 3mg/kg/ 21 days. Changes in natremia and GFR (CDK-EPI) were evaluated in 0,1,3 months of follow-up. Patients with combined chemotherapy were excluded. Results 137 patients were included. Mean age: 64 years. Men: 71.6%. Neoplasm: lung (76.8%), bladder (7.2%), melanoma (15.9%). Patients received 27.5% PEM; 26.1% ATZ; 46.4% NIV. Between all of them, 76% had received platinum previously. Up to 13.6% developed hyponatremia and 12.40% AKI 3 months later. The decrease in GFR was significantly greater in bladder neoplasm (mean GFR 42ml / min / m2 p <0.01) at three months. Bladder cancer was also the most frequent (but not significant) in reduced natremia (mean Na 135mEq / L p = 0.08). There were no differences according to drug administration or having received platinum previously. 61% were death, but none of them due to a renal event. Conclusion

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Electrolyte disorders in advanced non-small cell lung cancer patients treated with immune check-point inhibitors: A systematic review and meta-analysis

Critical Reviews in Oncology/Hematology ◽

10.1016/j.critrevonc.2020.102974 ◽

2020 ◽

Vol 151 ◽

pp. 102974

Author(s):

Luca Cantini ◽

Filippo Merloni ◽

Silvia Rinaldi ◽

Edoardo Lenci ◽

Giulia Marcantognini ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Cancer Patients ◽

Meta Analysis ◽

Small Cell ◽

Check Point ◽

Small Cell Lung ◽

Electrolyte Disorders ◽

Lung Cancer Patients ◽

Check Point Inhibitors

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Review of neurological side effects associated with checkpoint inhibitor therapy in cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.5_suppl.72 ◽

2020 ◽

Vol 38 (5_suppl) ◽

pp. 72-72

Author(s):

Lakshmi Manogna Chintalacheruvu ◽

Kushal Naha ◽

Vamsi Krishna Chilluru ◽

Donald C. Doll

Keyword(s):

Side Effects ◽

Confidence Interval ◽

Randomized Controlled Trials ◽

Cancer Patients ◽

Checkpoint Inhibitors ◽

Controlled Trials ◽

Close Monitoring ◽

Check Point ◽

Randomized Controlled ◽

Check Point Inhibitors

72 Background: Checkpoint inhibitors have demonstrated efficacy in many cancer types. Neurological side effects are not well studied with check point inhibitors therapy. We conducted systematic review and meta analysis to evaluate the incidence of neurological side effects among various check point inhibitors. Methods: Eligible studies were searched for in PubMed and Google scholar. We searched for randomized controlled trials with cancer patients treated with check point inhibitors with neurological adverse effects. A total of 26 randomized controlled trials involving 6110 patients met eligibility criteria for the study. Results: Incidence rate of all grade neurological side effects include 5.6%(95% confidence interval [CI], 5.4-6.7%). Most common side effects include Headache (4.6%) (95% confidence interval [CI] 3.7-4.7%) followed by peripheral neuropathy (0.3%) (95% confidence interval [CI] 0.1-0.5%). Ipilimumab plus Nivolumab is associated with higher risk of headache and serious neurological side effects including myasthenia gravis, encephalitis, toxic encephalopathy and seizures. Conclusions: The incidence of neurological side effects associated with immune checkpoint inhibitors is low but not negligable. Patients on combination immunotherapy need more close monitoring for serious neurological side effects.

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Risk of endocrine complications in cancer patients treated with immune check point inhibitors: a meta-analysis

Future Oncology ◽

10.2217/fon.15.222 ◽

2016 ◽

Vol 12 (3) ◽

pp. 413-425 ◽

Cited By ~ 70

Author(s):

Omar Abdel-Rahman ◽

Hesham ElHalawani ◽

Mona Fouad

Keyword(s):

Cancer Patients ◽

Meta Analysis ◽

Check Point ◽

Check Point Inhibitors ◽

Endocrine Complications

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MANAGEMENT OF ENDOCRINE DISEASE: Immune check point inhibitors-induced hypophysitis

Acta Endocrinologica ◽

10.1530/eje-19-0169 ◽

2019 ◽

Vol 181 (3) ◽

pp. R107-R118 ◽

Cited By ~ 13

Author(s):

Frédérique Albarel ◽

Frédéric Castinetti ◽

Thierry Brue

Keyword(s):

Clinical Symptoms ◽

High Dose ◽

Check Point ◽

Optimal Monitoring ◽

Key Points ◽

Check Point Inhibitors ◽

Immunomodulatory Therapies ◽

Specific Education

In recent years, the development of immunotherapy has constituted a revolution in the therapy for many cancers, with a specific toxicity profile including endocrine immune-related adverse events. Immune check point inhibitors (ICI)-induced hypophysitis is a common endocrine side effect, particularly with CTLA-4 antibodies and combination therapy, with frequent hormonal deficiencies at diagnosis. It can be difficult to evoke such diagnosis as the initial clinical symptoms are not specific (headache, asthenia…); thus, patients receiving such immunomodulatory therapies should be closely monitored by systematic hormone measurements, especially in the first weeks of treatment. Usually, hormonal deficiencies improve, except for corticotroph function. Despite a lack of large prospective studies on ICI-induced hypophysitis, some detailed longitudinal cohort studies have focused on such cases of hypophysitis and allow for optimal monitoring, follow-up and management of patients with this immune-related adverse event. In the case of ICI-induced hypophysitis, patients need long-term multidisciplinary follow-up, with specific education for those patients with corticotropin deficiency to allow them to be autonomous with their treatment. In this review, based on a clinical case, we detail the most relevant and novel aspects related to the incidence, diagnosis, treatment, evolution and management of hypophysitis induced by immunotherapy, with a focus on possible mechanisms and current recommendations and guidelines. Lastly, we emphasize several key points, such as the absence of indication to systematically treat with high-dose glucocorticoid and the pursuit of immunotherapy in such hypophysitis. These points should be kept in mind by oncologists and endocrinologists who treat and monitor patients treated by immunotherapy.

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Assessment of microsatellite instability (MSI) in cell free DNA (cfDNA) of colorectal cancers (CRC) patients (pts).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.672 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 672-672 ◽

Cited By ~ 2

Author(s):

Afsaneh Barzi ◽

Mihaela Campan ◽

Jonas Petterson ◽

Lan Du ◽

Tiffany Long ◽

...

Keyword(s):

Lynch Syndrome ◽

Primary Tumor ◽

Rapid Progression ◽

Check Point ◽

Specimen Collection ◽

Check Point Inhibitors ◽

A Prospective Study ◽

Microsatellite Alleles

672 Background: While there is accumulating evidence that tumor specific mutations can be accurately detected in cfDNA, the determination of MSI status in cfDNA has not been investigated, perhaps because the complexity of detecting tumor instability embedded within stutter amplification patterns generated from normal cfDNA was considered too challenging to allow the detection of altered microsatellite profiles. We explored the possibility of detecting MSI in cfDNA. Methods: Circulating cfDNA was isolated from Streck tubes from 13 patients with CRC; 6 pts had serial collections. Isolation and testing of cfDNA for MSI was performed using kits purchased from Promega. Microsatellite alterations were scored by comparing the amplicon stutter profiles of 5 mononucleotide markers generated from cfDNA to those present in genomic DNA extracted from buffy coats from the same pts. MSI was diagnosed based on a shift in the size of a predominant stutter peak together with a commensurate shift in the stutter profile resulting in the appearance of at least one new stutter in tumor-derived DNA compared to matched germline DNA. MSI was scored high when 30% or more of the markers showed MSI or low if present in less than 30% of the biomarkers examined. Results: No MSI was detected in 3 pts with microsatellite stable tumors and 2 Lynch syndrome pts with no evidence of disease. Five of six pts with MSI high tumors (sporadic and Lynch syndrome) had a detectable MSI high biomarker profile in cfDNA at baseline. Four pts with positive MSI in cfDNA started immunotherapy and had a decline in the relative amounts of tumor-derived microsatellite alleles in their subsequent specimens. The pt with MSI high in the primary tumor and no MSI in cfDNA had rapid progression on immunotherapy. Two other pts with MSI high who responded deeply to check point inhibitors had no evidence of MSI in cfDNA at the time of their specimen collection. In each case with MSI in cfDNA, the electrophoretic profile matched that in the respective primary tumor. Conclusions: Detection of MSI in cfDNA is feasible and may be reflective of burden of the disease. A prospective study to establish the validity of cfDNA in the diagnosis and follow up care in pts with metastatic CRC is planned.

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Abstract 673: The role of mass spectrometry-based serum proteomics signatures in predicting clinical outcomes in cancer patients treated with immune check point inhibitors (ICI)

10.1158/1538-7445.am2021-673 ◽

2021 ◽

Author(s):

Yoonhee Choi ◽

Jin Young Hwang ◽

Won Kyung Hur ◽

Myungwoo Nam ◽

Leeseul Kim ◽

...

Keyword(s):

Mass Spectrometry ◽

Cancer Patients ◽

Clinical Outcomes ◽

Check Point ◽

Serum Proteomics ◽

Check Point Inhibitors

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Should we be Afraid of Immune Check Point Inhibitors in Cancer Patients with Pre-Existing Rheumatic Diseases? Immunotherapy in Pre-Existing Rheumatic Diseases

Mediterranean Journal of Rheumatology ◽

10.31138/mjr.32.3.218 ◽

2021 ◽

Vol 32 (3) ◽

pp. 218

Author(s):

Kalliopi Klavdianou ◽

Konstantinos Melissaropoulos ◽

Alexandra Filippopoulou ◽

Dimitrios Daoussis

Keyword(s):

Cancer Patients ◽

Rheumatic Diseases ◽

Check Point ◽

Check Point Inhibitors

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Telemedicine as an Acceptable Model of Care in Advanced stage Cancer Patients in the Era of Coronavirus Disease 2019 – An Observational Study in a Tertiary Care Centre

Indian Journal of Palliative Care ◽

10.25259/ijpc_45_21 ◽

2021 ◽

Vol 27 ◽

pp. 306-312

Author(s):

Shreya Das Adhikari ◽

Swagata Biswas ◽

Seema Mishra ◽

Vinod Kumar ◽

Sachidanand Jee Bharti ◽

...

Keyword(s):

Cancer Patients ◽

Tertiary Care ◽

Routine Care ◽

Categorical Variables ◽

Care Centre ◽

Tertiary Care Centre ◽

Patients With Cancer ◽

Acceptable Model ◽

Advanced Stage Cancer

Objectives: The availability of routine care for patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic has become challenging, and the use of telemedicine can be promising in this area. The objective of the study is to evaluate the feasibility of telemedicine-based palliative interventions in cancer patients. Materials and Methods: This retrospective study was conducted in a tertiary care centre with 547 follow-up patients who used palliative medicine teleconsultation services. The following data were retrieved from the records: Patient’s reason for the call, the main barriers to a hospital visit, the assistance given to them by the physician on the call and the patients’ satisfaction with the service on a 4-point scale. The data were analysed using percentages for categorical variables and mean/standard deviation for quantitative variables. Results: Out of the 547 patients, 462 (84.46%) utilised voice calling service, and the major reason for not visiting the hospital were cited to be fear of contracting COVID-19 (37.3%), inability to attend due to health constraints (7.13%) and issues with transportation (48.8%). The majority of the calls (63.62%) calls were regarding uncontrolled symptoms of the primary diseases. A total of 402 (73.49%) patients were very satisfied, and a total of 399 (72.94%) decided to continue to use this medium in the future as well. Conclusion: Telemedicine is a good modality for the assessment of chronic pain and providing symptomatic supportive care in patients with cancer in the COIVD-19 pandemic.

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