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  P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27733

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    P3.15-26 - Safety of Nivolumab in Thoracic Malignancies: Results from a Single Institution in Bangladesh (ID 12040)

    12:00 - 13:30  |  Presenting Author(s): Md Shuayb
    • Abstract
    • Slides

    Background
    

    Nivolumab, an anti-PD-1 monoclonal antibody (IgG4), has emerged as a promising drug in the era of immunotherapy of today. Recent trials have demonstrated encouraging activity with favorable safety profile of nivolumab in patients with treatment-refractory lung cancer as well as esophageal cancer. However, experience of using immunotherapy is still quite new in a developing country like Bangladesh owing to its excessive cost and unavailability.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    A total of 3 patients have been treated with nivolumab at a dose of 3mg/kg every 2 weeks to date at our centre. Evidence of PD-L1 expression was not present in either of the patients. All were within the ECOG performance status ≤2, and none of them were on systemic corticosteroids or immunosuppressive therapy. First case: a 48-year old male, adenocarcinoma lung with brain metastases, TTF-1 positive and EGFR negative, was treated initially with craniotomy followed by whole brain irradiation. 4 cycles of pemetrexed/carboplatin followed by 6 cycles of maintenance pemetrexed were given but the disease progressed. Then he completed 4 cycles of docetaxel which again resulted with progressive disease (PD). Now he is on nivolumab, 6 cycles completed to date. Second case: A 62-year old female, adenocarcinoma lung with contralateral lung metastases, EGFR and ALK negative, was treated initially with concurrent chemoradiation with 3 cycles of pemetrexed/cisplatin. As the disease progressed, 4 cycles of docetaxel/carboplatin were given which again showed PD. Now he is on nivolumab, cycle-6 completed to date. Third case: A 75-year old male, squamous cell esophageal cancer at lower 3^rd, was non-surgical and non-chemo candidate because of uncontrolled diabetes and significant cardiac comorbidity. Nivolumab was started, and received 2 cycles.

    4c3880bb027f159e801041b1021e88e8 Result
    

    In the first and second cases, ‘stable disease’ was achieved with no serious immune-mediated reactions over the period of nivolumab therapy. When evaluated with Common Terminology Criteria for Adverse Events (CTCAE version 4.03), only grade-1 elevated creatinine was seen in both patients. There was no reported toxicity of endocrinopathy, enterocolitis, intestinal perforation, hemorrhage, neuropathy, pneumonitis, hepatitis or dermatitis. In the third case, patient developed, 7 days after cycle-2, grade-3 diarrhea along with hematemesis and hematochezia. On arrival at our emergency department, he was found to be life-threatening grade-4 enterolcolitis and he died before undergoing any intervention.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Nivolumab may delay disease progression with minimal toxicity but may sometimes be associated with severe immune-related events. Practice should be done with caution and prompt action is warranted once toxicity has developed in order to prevent fatality

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