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Takamoto Saijo



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    EP1.01 - Advanced NSCLC (ID 150)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.01-93 - Rare Immune Related Adverse Events by Immune Checkpoint Inhibitors in Clinical Practice (Now Available) (ID 1721)

      08:00 - 18:00  |  Presenting Author(s): Takamoto Saijo

      • Abstract
      • Slides

      Background

      Immune checkpoint inhibitors (ICIs) such as anti-PD-1 and PD-L1 antibodies including nivolumab/pembrolizumab and atezolizumab are available practically in Japan. While ICIs produce excellent antitumor activity and long-term survival, unexpected immune related adverse events (irAEs), which are different from those for cytotoxic drugs, have been reported. We experienced varieties of irAEs which have successfully been treated.

      Method

      We retrospectively analyzed irAEs in 50 NSCLC patients treated with ICIs as clinical practice from January 2016 to November 2018 in TODA Central General hospital.

      Result

      Nivolumab, pembrolizumab and atezolizumab was given in 27, 11 and 12 patients, respectively. The median age was 69 (43-84). Male/female: 40/10 patients, adenocarcinoma/squamous cell carcinoma/unclassified non-small cell carcinoma: 30/15/5 patients. Tissue proportional score for PD-L1 antibody was strongly positive/weakly positive/negative/unknown in 12/4/12/22 patients, respectively. The treatment response was CR/PR/SD/PD/NE in 3/14/2/22/9 patients, respectively. Various types of irAEs have been observed, exacerbation of rheumatoid arthritis: 1, hypothyroidism: 3, secondary adrenocortical insufficiency with ACTH isolated deficiency: 1, pneumonitis: 6, liver dysfunction: 1, neutropenia: 1, diarrhea: 1, rash: 3, infusion reaction: 1. Each irAEs had been basically managed according to algorism, such as treatment discontinuation, irritative treatment, steroid therapy, hormone replacement therapy etc. One patient, who developed multiple irAEs, diarrhea, liver dysfunction and neutropenia at same time, recovered from irAEs quickly by supportive care including steroid pulse therapy.

      Conclusion

      A variety of unexpected irAEs have been experienced in NSCLC patients treated with ICIs, however, excellent tumor response was observed in 10 of 13 patients who developed irAEs. In patient who showed multiple irAEs, tumor size was decreased significantly by nivolumab therapy and tumor progression was not observed 33 months after the final nivolumab administration. IrAEs associated with ICIs are diverse and difficult to predict, so safety management and early detection are important.

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