Background The landscape of cancer treatment has changed drastically since the development of Immune Checkpoint Inhibitors (ICI). ICIs have become the cornerstone to various cancer treatments.1 2 The adverse effect (AE) profile of ICI is different than conventional chemotherapy. Nivolumab and pembrolizumab target programmed cell death-1 T-cell receptor, whereas programmed death ligand-1 is targeted by atezolizumab and durvalumab.3 4 Easy tolerability and lack of myelosuppresion make immunotherapy an attractive treatment option. Some AEs can be severe, life-threatening, or even fatal (grade III and higher).1 Much of the data regarding AE profile is from clinical trials. The aim of our study is to review real world single institution AE data on the most commonly utilized ICIs.
Methods We reviewed a total of 229 patient charts who had received pembrolizumab, nivolumab, durvalumab or atezolizumab at Saint Francis Hospital in Hartford, CT, USA. 53 patients were excluded given lack of records or because they received less than 2 cycles of treatment.
Results 176 patients were included in the final analysis. ICIs were discontinued in 25/176 (14.2%) patients secondary to AE. 24/176 (13.6%) patients had grade III or higher AEs reported. 10/95 (10.5%) patients who received pembrolizumab developed grade III/IV AEs (8 pneumonitis, 2 nephritis). 5/45 (11.1%) patients treated with nivolumab developed grade III/IV AEs (2 pneumonitis, 1 new-onset DKA, 1 nephritis, 1 myositis). 8/19 (42.1%) receiving durvalumab had grade III or higher AEs (6 pneumonitis, 1 sepsis, 1 colitis). Lastly, 1/17 (5.8%) in atezolizumab group developed grade III/IV AE (colitis). 96/176 (54.5%) patients had one or more ER visit and 91/176 (51.7%) were admitted to the hospital for various reasons one or more times.
Conclusions ICIs have a relatively safe drug profile. 86.4% of our studied population did not develop any grade III or higher AEs. The main reason for ICI discontinuation was disease progression rather than AE. The most common grade III/IV AE was pneumonitis. Durvalumab had the highest incidence of AE, pneumonitis, which is likely related to radiation use prior to immunotherapy.
Ethics Approval Institutional Review Board approval - IRB#: SFH-19–72
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