BACKGROUND: In the last years immunotherapy has revolutionized the treatment of non-small cell lung cancer (NSCLC) not supported by a driver mutation. Immunotherapy related adverse events (irAEs) have a unique toxicity profiles distinct from the toxicities of classical chemotherapy treatment relating to their mechanism of action. We analyzed some serious and uncommon life-threatening irAEs, needing a change in the therapeutic strategy. METHOD: Between October 2018 and October 2020, 63 NSCLC patients underwent immunotherapy. Thirty-eight patients underwent first-line Pembrolizumab, 200 mg every 21 days (Group A). Twenty patients were treated in second line with Pembrolizumab 200 mg every 21 days or Nivolumab 240 mg every 14 days or Atezolizumab 800 mg every 14 days (Group B). Five stage III patients treated after radio chemotherapy with Durvalumab 1500 mg every 14 days (Group C). RESULTS: We experienced: a) 2 bowel perforations (3.2%), necessitating Hartmann's resection. Only one of the two patients restored immunotherapy; b) 1 chronic renal insufficiency (1.6%, creatinine up to 8 mg/dL) and 2 severe hypertransaminasemias (3.2%, up to 65 U/L), requiring the immediate and definitive interruption of ICIs; c) 2 pericardial effusions (3.2%), of which one needed subxiphoid pericardiocentesis for cardiac tamponade. Patient restored immunotherapy after resolution of the acute event. CONCLUSIONS: Immunotherapy include monoclonal antibodies reducing the suppression of effector T cells and improving the tumor-specific immune responses. Most common irAEs are evident in mild and reversible form, but sometimes life-threatening irEAs show up. Therefore, further clinical trials needed to increase knowledge of drugs and prevent unexpected irAEs.
BACKGROUND: In the last years immunotherapy has revolutionized the treatment of non-small cell lung cancer (NSCLC) not supported by a driver mutation. Immunotherapy related adverse events (irAEs) have a unique toxicity profiles distinct from the toxicities of classical chemotherapy treatment relating to their mechanism of action. We analyzed some serious and uncommon life-threatening irAEs, needing a change in the therapeutic strategy. METHOD: Between October 2018 and October 2020, 63 NSCLC patients underwent immunotherapy. Thirty-eight patients underwent first-line Pembrolizumab, 200 mg every 21 days (Group A). Twenty patients were treated in second line with Pembrolizumab 200 mg every 21 days or Nivolumab 240 mg every 14 days or Atezolizumab 800 mg every 14 days (Group B). Five stage III patients treated after radio chemotherapy with Durvalumab 1500 mg every 14 days (Group C). RESULTS: We experienced: a) 2 bowel perforations (3.2%), necessitating Hartmann's resection. Only one of the two patients restored immunotherapy; b) 1 chronic renal insufficiency (1.6%, creatinine up to 8 mg/dL) and 2 severe hypertransaminasemias (3.2%, up to 65 U/L), requiring the immediate and definitive interruption of ICIs; c) 2 pericardial effusions (3.2%), of which one needed subxiphoid pericardiocentesis for cardiac tamponade. Patient restored immunotherapy after resolution of the acute event. CONCLUSIONS: Immunotherapy include monoclonal antibodies reducing the suppression of effector T cells and improving the tumor-specific immune responses. Most common irAEs are evident in mild and reversible form, but sometimes life-threatening irEAs show up. Therefore, further clinical trials needed to increase knowledge of drugs and prevent unexpected irAEs.
Authors: Joe-Elie Salem; Ali Manouchehri; Melissa Moey; Bénédicte Lebrun-Vignes; Lisa Bastarache; Antoine Pariente; Aurélien Gobert; Jean-Philippe Spano; Justin M Balko; Marc P Bonaca; Dan M Roden; Douglas B Johnson; Javid J Moslehi Journal: Lancet Oncol Date: 2018-11-12 Impact factor: 41.316
Authors: Achim Rittmeyer; Fabrice Barlesi; Daniel Waterkamp; Keunchil Park; Fortunato Ciardiello; Joachim von Pawel; Shirish M Gadgeel; Toyoaki Hida; Dariusz M Kowalski; Manuel Cobo Dols; Diego L Cortinovis; Joseph Leach; Jonathan Polikoff; Carlos Barrios; Fairooz Kabbinavar; Osvaldo Arén Frontera; Filippo De Marinis; Hande Turna; Jong-Seok Lee; Marcus Ballinger; Marcin Kowanetz; Pei He; Daniel S Chen; Alan Sandler; David R Gandara Journal: Lancet Date: 2016-12-13 Impact factor: 79.321
Authors: Shirish Gadgeel; Delvys Rodríguez-Abreu; Giovanna Speranza; Emilio Esteban; Enriqueta Felip; Manuel Dómine; Rina Hui; Maximilian J Hochmair; Philip Clingan; Steven F Powell; Susanna Yee-Shan Cheng; Helge G Bischoff; Nir Peled; Francesco Grossi; Ross R Jennens; Martin Reck; Edward B Garon; Silvia Novello; Belén Rubio-Viqueira; Michael Boyer; Takayasu Kurata; Jhanelle E Gray; Jing Yang; Tuba Bas; M Catherine Pietanza; Marina C Garassino Journal: J Clin Oncol Date: 2020-03-09 Impact factor: 44.544
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: Jhanelle E Gray; Augusto Villegas; Davey Daniel; David Vicente; Shuji Murakami; Rina Hui; Takayasu Kurata; Alberto Chiappori; Ki Hyeong Lee; Byoung Chul Cho; David Planchard; Luis Paz-Ares; Corinne Faivre-Finn; Johan F Vansteenkiste; David R Spigel; Catherine Wadsworth; Maria Taboada; Phillip A Dennis; Mustafa Özgüroğlu; Scott J Antonia Journal: J Thorac Oncol Date: 2019-10-14 Impact factor: 15.609