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Pembrolizumab-related toxicity in patients with advanced melanoma
Florence de Roo1, Amritpreet Singh2, Eric Zheng3
1Medical Oncology Fellow, Southern Blood and Cancer Service, Health New Zealand - Te Whatu Ora Southern, Dunedin Hospital, Dunedin, New Zealand; PhD Candidate, Department of Pathology, University of Otago, Dunedin, New Zealand.
Aim:
Pembrolizumab has revolutionised the treatment of melanoma. Immune checkpoint inhibitors (ICI) are well tolerated in trials, but the real-world incidence of toxicities and their management are not well described. We investigated the incidence and management of toxicities in New Zealand.
Methods:
A retrospective review was conducted on patients with metastatic melanoma treated with pembrolizumab at Wellington and Waikato Hospitals between March 2016 and September 2021. The occurrence, severity and management of toxicities was recorded.
Results:
Of the 273 patients, 42% experienced treatment-related toxicity. Seventy-five percent of toxicities were grade 1/2 (mild), 25% grade 3/4 (moderate or life-threatening) and <1% grade 5 (fatal). Per organ system, 28% were dermatological, 18% gastrointestinal, 14% endocrine, 9% musculoskeletal, 5% respiratory, 5% renal and <1% haematological, cardiac or neurological. Thirteen percent of patients were hospitalised and 21% had pembrolizumab stopped due to toxicity. There were 45 referrals to subspecialty services.
Conclusion:
Pembrolizumab-related toxicities are common and mostly mild but can require protracted courses of steroids and specialty referrals. Prospective data on toxicity and the management of toxicities from ICIs are needed.
Insights
Immune checkpoint inhibitors like pembrolizumab are common in melanoma treatment. Real-world data show toxicities occur in 42% of patients, mostly mild, but require management.
Area of Science:
- Oncology
- Immunology
- Dermatology
Background:
- Pembrolizumab, an immune checkpoint inhibitor (ICI), has transformed melanoma treatment.
- While clinical trials suggest good tolerability, real-world data on ICI toxicities and their management are limited.
Purpose of the Study:
- To investigate the incidence, severity, and management of toxicities associated with pembrolizumab treatment in metastatic melanoma patients in New Zealand.
Main Methods:
- Retrospective review of 273 metastatic melanoma patients treated with pembrolizumab.
- Data collected on toxicity occurrence, severity, management, hospitalizations, treatment cessation, and subspecialty referrals.
Main Results:
- 42% of patients experienced treatment-related toxicity, with 75% being mild (Grade 1/2) and 25% moderate to severe (Grade 3/4).
- Dermatological (28%) and gastrointestinal (18%) toxicities were most frequent. 13% required hospitalization, and 21% discontinued pembrolizumab due to toxicity.
Conclusions:
- Pembrolizumab-related toxicities are frequent but predominantly mild, often necessitating steroid treatment and specialist consultations.
- Further prospective studies are required to comprehensively understand ICI toxicity profiles and optimize management strategies.
