1233 Impact of infections occurring in patients receiving immune checkpoint inhibitors for renal cell carcinoma (RCC)

BackgroundImmune checkpoint inhibitor (ICI)-based regimens including pembrolizumab/axitinib (P/A), nivolumab/cabozantinib (N/C), and nivolumab/ipilimumab (N/I) have improved outcomes in patients with RCC. While immune related adverse events are a well-known complication contributing to treatment del...

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Published in:Journal for immunotherapy of cancer 2023-11, Vol.11 (Suppl 1), p.A1360-A1360
Main Authors: Wiechmann, Catherine, Gee, Kelly, Burns, Ethan, Xu, Jiaqiong, Zhang, Yuqi, Crenshaw, Aubrey, Esmail, Abdullah, Kieser, Ryan, Umoru, Godsfavour, Muhsen, Ibrahim, Sun, Kai, Gong, Zimu, Shah, Shivan, Singh, Monisha, Zhang, Jun, Efstathiou, Eleni, Abdelrahim, Maen
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Kidney cancer
Regular and Young Investigator Award Abstracts
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container_end_page A1360
container_issue Suppl 1
container_start_page A1360
container_title Journal for immunotherapy of cancer
container_volume 11
creator Wiechmann, Catherine
Gee, Kelly
Burns, Ethan
Xu, Jiaqiong
Zhang, Yuqi
Crenshaw, Aubrey
Esmail, Abdullah
Kieser, Ryan
Umoru, Godsfavour
Muhsen, Ibrahim
Sun, Kai
Gong, Zimu
Shah, Shivan
Singh, Monisha
Zhang, Jun
Efstathiou, Eleni
Abdelrahim, Maen
description BackgroundImmune checkpoint inhibitor (ICI)-based regimens including pembrolizumab/axitinib (P/A), nivolumab/cabozantinib (N/C), and nivolumab/ipilimumab (N/I) have improved outcomes in patients with RCC. While immune related adverse events are a well-known complication contributing to treatment delays, discontinuation, and morbidity, little is reported on the incidence and outcomes of infections. This study aims to assess the incidence, risk factors, and outcomes of infections occurring in patients with RCC receiving ICIs.MethodsData was collected from 7 hospitals for patients who received P/A, N/C, or N/I for RCC from 1/2017–8/2021. Date of last follow-up was 12/2022. Covariates compared among infected and non-infected cohorts included age, gender, race, comorbidities, and ECOG. Risk factors for infection were assessed by univariable analysis with reported odds ratio (OR) and 95% confidence interval (CI). Outcome measures included all-cause emergency department (ED) visits, inpatient, and intensive care unit (ICU) admissions, median number of ICI cycles, progression free survival (PFS) and overall survival (OS). OS/PFS were evaluated using the Kaplan-Meier model. P-value 1 (OR 6.22, [95% CI 1.92, 19.73], p=0.002) was associated with higher risk of developing infections. Infected patients had a higher rate of ED (14 (27.45%) vs 13 (13.27%), p= 0.033), inpatient (40 (78.43%) vs 42 (42.86%), p
doi_str_mv 10.1136/jitc-2023-SITC2023.1233
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While immune related adverse events are a well-known complication contributing to treatment delays, discontinuation, and morbidity, little is reported on the incidence and outcomes of infections. This study aims to assess the incidence, risk factors, and outcomes of infections occurring in patients with RCC receiving ICIs.MethodsData was collected from 7 hospitals for patients who received P/A, N/C, or N/I for RCC from 1/2017–8/2021. Date of last follow-up was 12/2022. Covariates compared among infected and non-infected cohorts included age, gender, race, comorbidities, and ECOG. Risk factors for infection were assessed by univariable analysis with reported odds ratio (OR) and 95% confidence interval (CI). Outcome measures included all-cause emergency department (ED) visits, inpatient, and intensive care unit (ICU) admissions, median number of ICI cycles, progression free survival (PFS) and overall survival (OS). OS/PFS were evaluated using the Kaplan-Meier model. P-value &lt;0.05 was considered statistically significant.ResultsThere were 149 patients included; 54 (36.24%), 34 (22.82%), and 61 (40.94%) received P/A, N/C, N/I, respectively. At least one infection was documented in 51 (34.2%) patients, of which 18 (35.29%), 12 (23.53%), 21 (41.18%) received P/A, N/C, N/I, respectively. There was no statistically significant difference in infectious risk between the three regimens. ECOG &gt;1 (OR 6.22, [95% CI 1.92, 19.73], p=0.002) was associated with higher risk of developing infections. Infected patients had a higher rate of ED (14 (27.45%) vs 13 (13.27%), p= 0.033), inpatient (40 (78.43%) vs 42 (42.86%), p&lt;0.001), and ICU admissions (13 (25.49%) vs 2 (2.04%), p&lt; 0.001) than non-infected, and trended toward both a shorter PFS (7.27 [95% CI 4.97–16.43] vs 11.5 [95% CI 6.23–36.33], p=0.36) and OS (9.97 [95% CI 5.5–32.53] vs not reached, p=0.10), respectively. Infections did not impact number of cycles received compared to non-infected (5 [3–15] vs 4 [3–16], p=0.86). At last follow-up, there was a higher proportion of all-cause deaths in the infected vs non-infected cohort (28 [54.90%] vs (37 [37.76%], p=0.045); of these 17 (60.71%), 5 (17.86%), 5 (17.86%), and 1 (3.57%) died due to primary disease, infection, multiorgan failure, and ‘other’, respectively.ConclusionsInfections in patients receiving ICIs for metastatic RCC are common and the risk is similar across regimens. Infections are associated with a higher hospitalization rate, all-cause mortality, and trend toward poorer survival. Strategies to minimize infectious processes to optimize outcomes are needed.</description><identifier>EISSN: 2051-1426</identifier><identifier>DOI: 10.1136/jitc-2023-SITC2023.1233</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd</publisher><subject>Immunotherapy ; Infections ; Kidney cancer ; Regular and Young Investigator Award Abstracts</subject><ispartof>Journal for immunotherapy of cancer, 2023-11, Vol.11 (Suppl 1), p.A1360-A1360</ispartof><rights>Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jitc.bmj.com/content/11/Suppl_1/A1360.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://jitc.bmj.com/content/11/Suppl_1/A1360.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,27924,27925,37012,55350,77660,77686</link.rule.ids></links><search><creatorcontrib>Wiechmann, Catherine</creatorcontrib><creatorcontrib>Gee, Kelly</creatorcontrib><creatorcontrib>Burns, Ethan</creatorcontrib><creatorcontrib>Xu, Jiaqiong</creatorcontrib><creatorcontrib>Zhang, Yuqi</creatorcontrib><creatorcontrib>Crenshaw, Aubrey</creatorcontrib><creatorcontrib>Esmail, Abdullah</creatorcontrib><creatorcontrib>Kieser, Ryan</creatorcontrib><creatorcontrib>Umoru, Godsfavour</creatorcontrib><creatorcontrib>Muhsen, Ibrahim</creatorcontrib><creatorcontrib>Sun, Kai</creatorcontrib><creatorcontrib>Gong, Zimu</creatorcontrib><creatorcontrib>Shah, Shivan</creatorcontrib><creatorcontrib>Singh, Monisha</creatorcontrib><creatorcontrib>Zhang, Jun</creatorcontrib><creatorcontrib>Efstathiou, Eleni</creatorcontrib><creatorcontrib>Abdelrahim, Maen</creatorcontrib><title>1233 Impact of infections occurring in patients receiving immune checkpoint inhibitors for renal cell carcinoma (RCC)</title><title>Journal for immunotherapy of cancer</title><addtitle>J Immunother Cancer</addtitle><description>BackgroundImmune checkpoint inhibitor (ICI)-based regimens including pembrolizumab/axitinib (P/A), nivolumab/cabozantinib (N/C), and nivolumab/ipilimumab (N/I) have improved outcomes in patients with RCC. While immune related adverse events are a well-known complication contributing to treatment delays, discontinuation, and morbidity, little is reported on the incidence and outcomes of infections. This study aims to assess the incidence, risk factors, and outcomes of infections occurring in patients with RCC receiving ICIs.MethodsData was collected from 7 hospitals for patients who received P/A, N/C, or N/I for RCC from 1/2017–8/2021. Date of last follow-up was 12/2022. Covariates compared among infected and non-infected cohorts included age, gender, race, comorbidities, and ECOG. Risk factors for infection were assessed by univariable analysis with reported odds ratio (OR) and 95% confidence interval (CI). Outcome measures included all-cause emergency department (ED) visits, inpatient, and intensive care unit (ICU) admissions, median number of ICI cycles, progression free survival (PFS) and overall survival (OS). OS/PFS were evaluated using the Kaplan-Meier model. P-value &lt;0.05 was considered statistically significant.ResultsThere were 149 patients included; 54 (36.24%), 34 (22.82%), and 61 (40.94%) received P/A, N/C, N/I, respectively. At least one infection was documented in 51 (34.2%) patients, of which 18 (35.29%), 12 (23.53%), 21 (41.18%) received P/A, N/C, N/I, respectively. There was no statistically significant difference in infectious risk between the three regimens. ECOG &gt;1 (OR 6.22, [95% CI 1.92, 19.73], p=0.002) was associated with higher risk of developing infections. Infected patients had a higher rate of ED (14 (27.45%) vs 13 (13.27%), p= 0.033), inpatient (40 (78.43%) vs 42 (42.86%), p&lt;0.001), and ICU admissions (13 (25.49%) vs 2 (2.04%), p&lt; 0.001) than non-infected, and trended toward both a shorter PFS (7.27 [95% CI 4.97–16.43] vs 11.5 [95% CI 6.23–36.33], p=0.36) and OS (9.97 [95% CI 5.5–32.53] vs not reached, p=0.10), respectively. Infections did not impact number of cycles received compared to non-infected (5 [3–15] vs 4 [3–16], p=0.86). At last follow-up, there was a higher proportion of all-cause deaths in the infected vs non-infected cohort (28 [54.90%] vs (37 [37.76%], p=0.045); of these 17 (60.71%), 5 (17.86%), 5 (17.86%), and 1 (3.57%) died due to primary disease, infection, multiorgan failure, and ‘other’, respectively.ConclusionsInfections in patients receiving ICIs for metastatic RCC are common and the risk is similar across regimens. Infections are associated with a higher hospitalization rate, all-cause mortality, and trend toward poorer survival. Strategies to minimize infectious processes to optimize outcomes are needed.</description><subject>Immunotherapy</subject><subject>Infections</subject><subject>Kidney cancer</subject><subject>Regular and Young Investigator Award Abstracts</subject><issn>2051-1426</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>DOA</sourceid><recordid>eNpFkcFK5TAUhosgKOozGHDjLKpJTtr0Lofi6AVhYNR1SE4TTb1tapo7w-zc-KI-ial3ZDY54efj5yRfUZwyesEY1Je9T1hyyqG8W9-3y-WCcYC94pDTipVM8PqgOJnnnlLKKEDTNIfFnwV5f31bD5PGRIIjfnQWkw_jTALiNkY_PuaQTDp5O6aZRIvW__5Mh2E7WoJPFp-n4MeUuSdvfApxJi7EjI56Q9Bu8qEj-jEMmpz_attvx8W-05vZnvybR8XDj6v79qa8_Xm9br_floY1EkpJJSDrmqqRxtQrjkCdE1KjBApVpQVIyUVnLK85rEztui7DwLWwdCWwgaNivevtgu7VFP2g418VtFefQYiPSsfkcWOVll1npKyQaieYcJobKYQVlbCmqhzmrrNd1xTDy9bOSfVhG_MLZ8XzZ4q88UpmCnaUGfr_AKNqkaQWSWpxo74kqcUAfACgUokR</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Wiechmann, Catherine</creator><creator>Gee, Kelly</creator><creator>Burns, Ethan</creator><creator>Xu, Jiaqiong</creator><creator>Zhang, Yuqi</creator><creator>Crenshaw, Aubrey</creator><creator>Esmail, Abdullah</creator><creator>Kieser, Ryan</creator><creator>Umoru, Godsfavour</creator><creator>Muhsen, Ibrahim</creator><creator>Sun, Kai</creator><creator>Gong, Zimu</creator><creator>Shah, Shivan</creator><creator>Singh, Monisha</creator><creator>Zhang, Jun</creator><creator>Efstathiou, Eleni</creator><creator>Abdelrahim, Maen</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>K9.</scope><scope>DOA</scope></search><sort><creationdate>20231101</creationdate><title>1233 Impact of infections occurring in patients receiving immune checkpoint inhibitors for renal cell carcinoma (RCC)</title><author>Wiechmann, Catherine ; Gee, Kelly ; Burns, Ethan ; Xu, Jiaqiong ; Zhang, Yuqi ; Crenshaw, Aubrey ; Esmail, Abdullah ; Kieser, Ryan ; Umoru, Godsfavour ; Muhsen, Ibrahim ; Sun, Kai ; Gong, Zimu ; Shah, Shivan ; Singh, Monisha ; Zhang, Jun ; Efstathiou, Eleni ; Abdelrahim, Maen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b1873-7073c1d8587bb692c30ff47ac730355a437724dbe26239b6fddd8532a4e094c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Immunotherapy</topic><topic>Infections</topic><topic>Kidney cancer</topic><topic>Regular and Young Investigator Award Abstracts</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wiechmann, Catherine</creatorcontrib><creatorcontrib>Gee, Kelly</creatorcontrib><creatorcontrib>Burns, Ethan</creatorcontrib><creatorcontrib>Xu, Jiaqiong</creatorcontrib><creatorcontrib>Zhang, Yuqi</creatorcontrib><creatorcontrib>Crenshaw, Aubrey</creatorcontrib><creatorcontrib>Esmail, Abdullah</creatorcontrib><creatorcontrib>Kieser, Ryan</creatorcontrib><creatorcontrib>Umoru, Godsfavour</creatorcontrib><creatorcontrib>Muhsen, Ibrahim</creatorcontrib><creatorcontrib>Sun, Kai</creatorcontrib><creatorcontrib>Gong, Zimu</creatorcontrib><creatorcontrib>Shah, Shivan</creatorcontrib><creatorcontrib>Singh, Monisha</creatorcontrib><creatorcontrib>Zhang, Jun</creatorcontrib><creatorcontrib>Efstathiou, Eleni</creatorcontrib><creatorcontrib>Abdelrahim, Maen</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Directory of Open Access Journals(OpenAccess)</collection><jtitle>Journal for immunotherapy of cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wiechmann, Catherine</au><au>Gee, Kelly</au><au>Burns, Ethan</au><au>Xu, Jiaqiong</au><au>Zhang, Yuqi</au><au>Crenshaw, Aubrey</au><au>Esmail, Abdullah</au><au>Kieser, Ryan</au><au>Umoru, Godsfavour</au><au>Muhsen, Ibrahim</au><au>Sun, Kai</au><au>Gong, Zimu</au><au>Shah, Shivan</au><au>Singh, Monisha</au><au>Zhang, Jun</au><au>Efstathiou, Eleni</au><au>Abdelrahim, Maen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>1233 Impact of infections occurring in patients receiving immune checkpoint inhibitors for renal cell carcinoma (RCC)</atitle><jtitle>Journal for immunotherapy of cancer</jtitle><stitle>J Immunother Cancer</stitle><date>2023-11-01</date><risdate>2023</risdate><volume>11</volume><issue>Suppl 1</issue><spage>A1360</spage><epage>A1360</epage><pages>A1360-A1360</pages><eissn>2051-1426</eissn><abstract>BackgroundImmune checkpoint inhibitor (ICI)-based regimens including pembrolizumab/axitinib (P/A), nivolumab/cabozantinib (N/C), and nivolumab/ipilimumab (N/I) have improved outcomes in patients with RCC. While immune related adverse events are a well-known complication contributing to treatment delays, discontinuation, and morbidity, little is reported on the incidence and outcomes of infections. This study aims to assess the incidence, risk factors, and outcomes of infections occurring in patients with RCC receiving ICIs.MethodsData was collected from 7 hospitals for patients who received P/A, N/C, or N/I for RCC from 1/2017–8/2021. Date of last follow-up was 12/2022. Covariates compared among infected and non-infected cohorts included age, gender, race, comorbidities, and ECOG. Risk factors for infection were assessed by univariable analysis with reported odds ratio (OR) and 95% confidence interval (CI). Outcome measures included all-cause emergency department (ED) visits, inpatient, and intensive care unit (ICU) admissions, median number of ICI cycles, progression free survival (PFS) and overall survival (OS). OS/PFS were evaluated using the Kaplan-Meier model. P-value &lt;0.05 was considered statistically significant.ResultsThere were 149 patients included; 54 (36.24%), 34 (22.82%), and 61 (40.94%) received P/A, N/C, N/I, respectively. At least one infection was documented in 51 (34.2%) patients, of which 18 (35.29%), 12 (23.53%), 21 (41.18%) received P/A, N/C, N/I, respectively. There was no statistically significant difference in infectious risk between the three regimens. ECOG &gt;1 (OR 6.22, [95% CI 1.92, 19.73], p=0.002) was associated with higher risk of developing infections. Infected patients had a higher rate of ED (14 (27.45%) vs 13 (13.27%), p= 0.033), inpatient (40 (78.43%) vs 42 (42.86%), p&lt;0.001), and ICU admissions (13 (25.49%) vs 2 (2.04%), p&lt; 0.001) than non-infected, and trended toward both a shorter PFS (7.27 [95% CI 4.97–16.43] vs 11.5 [95% CI 6.23–36.33], p=0.36) and OS (9.97 [95% CI 5.5–32.53] vs not reached, p=0.10), respectively. Infections did not impact number of cycles received compared to non-infected (5 [3–15] vs 4 [3–16], p=0.86). At last follow-up, there was a higher proportion of all-cause deaths in the infected vs non-infected cohort (28 [54.90%] vs (37 [37.76%], p=0.045); of these 17 (60.71%), 5 (17.86%), 5 (17.86%), and 1 (3.57%) died due to primary disease, infection, multiorgan failure, and ‘other’, respectively.ConclusionsInfections in patients receiving ICIs for metastatic RCC are common and the risk is similar across regimens. Infections are associated with a higher hospitalization rate, all-cause mortality, and trend toward poorer survival. Strategies to minimize infectious processes to optimize outcomes are needed.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd</pub><doi>10.1136/jitc-2023-SITC2023.1233</doi><oa>free_for_read</oa></addata></record>
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subjects Immunotherapy
Infections
Kidney cancer
Regular and Young Investigator Award Abstracts
title 1233 Impact of infections occurring in patients receiving immune checkpoint inhibitors for renal cell carcinoma (RCC)
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