Myat M. Han

Adverse Effects of Immune Checkpoint Therapy in Cancer Patients Visiting the Emergency Department of a Comprehensive Cancer Center

Study objective Cancer immunotherapy is evolving rapidly and is transforming cancer care. During the last decade, immune checkpoint therapies have been developed to enhance the immune response; however, specific adverse effects related to autoimmunity are increasingly apparent. This study aims to fill the knowledge gap related to the spectrum of immune‐related adverse effects among cancer patients visiting emergency departments (EDs). Methods We performed a retrospective review of patients treated with immune checkpoint therapy who visited the ED of a comprehensive cancer center between March 1, 2011, and February 29, 2016. Immune‐related adverse effects from the ED visits were identified and profiled. We analyzed the association of each immune‐related adverse effect with overall survival from the ED visit to death. Results We identified 1,026 visits for 628 unique patients; of these, 257 visits (25.0%) were related to one or more immune‐related adverse effects. Diarrhea was the most common one leading to an ED visit. The proportions of ED visits associated with diarrhea, hypophysitis, thyroiditis, pancreatitis, or hepatitis varied significantly by immune checkpoint therapy agent. Colitis was significantly associated with better prognosis, whereas pneumonitis was significantly associated with worse survival. Conclusion Cancer patients treated with ipilimumab, nivolumab, or pembrolizumab may have a spectrum of immune‐related adverse effects that require emergency care. Future studies will need to update this profile as further novel immunotherapeutic agents are added.

A Systematic Review and Meta-Analysis of Randomized Controlled Trials to Evaluate the Risk of Hematological Toxicities in Patients with Multiple Myeloma Treated with Daratumumab

S242 p 1⁄4 0.70); asthenia, 0.84 (95% CI: 0.38 e 1.85, p 1⁄4 0.66); and insomnia, 1.05 (95% CI: 0.80 e 1.36; p 1⁄4 0.71). The RR of highgrade adverse effects were as follows: nausea, 1.92 (95% CI: 0.17 e 21.60; p 1⁄4 0.59); diarrhea, 1.43 (95% CI: 0.75 e 2.74, p 1⁄4 0.27); fatigue, 1.87 (95% CI: 0.99 e 3.52; p 1⁄4 0.051); asthenia, 0.81 (95% CI: 0.30 e 2.14, p 1⁄4 0.67); and insomnia, 0.30 (95% CI: 0.04 e 1.93; p 1⁄4 0.20). Conclusions: Addition of daratumumab did not increase the risk of gastrointestinal toxicities and healthrelated quality of life events in patients with multiple myeloma compared to control arm, while contributing substantial survival benefits.