C77-49 Steroid-refractory Immune Checkpoint Inhibitor Pneumonitis: A Comparison of Therapies
M Ploch, S Zhao, A Wang, A M Attia, R Wilson, M Nikahd, T Swanson, K Patel, B W Kinder, R C Ishizawar, J Clark, L Wei, C T Lee, P Reid, A Dayan Lecaros Zavalla, J Tuesta Delgado, K Bernal Medina, A Sheshadri, D H Owen, K HoAbstract
Rationale
Immune checkpoint inhibitors (ICIs) have revolutionized cancer care, improving cancer-related mortality in a variety of solid tumor malignancies. ICI pneumonitis (ICI-p) is an autoimmune-mediated adverse effect of ICIs that results in treatment-related morbidity and mortality. Corticosteroids are the mainstay of treatment; however, a subset of patients have lung inflammation not responsive to steroids (steroid-refractory ICI-p), resulting in morbidity and mortality. Though society guidelines recommend several non-steroid therapeutic treatments, efficacy data is limited.
Methods
We conducted a multicenter retrospective cohort study at three academic medical centers of patients with steroid-refractory ICI-p. Inclusion criteria consisted of cancer patients who developed ICI-p with clinical worsening of pneumonitis after a minimum of 48 hours of high-dose corticosteroids (prednisone 1-2 mg/kg/day or more) or no clinical improvement after at least 14 days of high-dose corticosteroids. Demographic characteristics, pneumonitis severity (CTCAE grading), pneumonitis resolution (symptomatic and radiographic resolution achieved with a steroid dose equivalent to prednisone </=10 mg daily) and overall survival were recorded. Therapeutic medications and baseline characteristics were compared among patients with and without pneumonitis resolution. The Kaplan-Meier method was used to compare overall survival between treatment groups.
Results
72 patients with steroid-refractory ICI-p treated with steroid sparing agents were identified; 10 were treated with more than one non-steroid therapeutic agent. Of the 72 patients, 21 (29.2%) had pneumonitis resolution and 51 (70.8%) did not. Fifty-five received infliximab, 22 received intravenous immunoglobulin (IVIG), 8 received tocilizumab, 4 received rituximab, 2 received mycophenolate, 1 received cyclophosphamide, and 1 received abatacept. There were no differences in prior chest radiation (p = 0.37), history of lung cancer (p = 0.44, Table 1), type of immunotherapy (p = 0.20), and days from pneumonitis diagnosis to steroid initiation (p = 0.62) between patients with and without pneumonitis resolution. There was no difference in pneumonitis resolution between patients who received infliximab (p = 0.76), intravenous immunoglobulin (IVIG, p = 1.00), or tocilizumab (p = 1.00, Table 1). There was no difference in overall survival amongst the treatment groups.
Conclusions
No specific treatment for steroid-refractory ICI-p was associated with superior pneumonitis resolution. Larger studies and medications studied in comparison clinical trials are needed to determine the optimal non-steroid immune suppressant treatment for steroid-refractory ICI-p.
This abstract is funded by: National Institutes of Health