Safety of immune checkpoint inhibitors in cancer patients with hepatitis C virus infection
Menée auprès de 40 patients atteints d'un cancer et infectés par le virus de l'hépatite B (âge médian : 64 ans) sur la période 2012-2019, cette étude rétrospective analyse la survenue d'événéments indésirables en lien avec une utilisation d'inhibiteurs de points de contrôle immunitaire
Background : The safety of immune checkpoint inhibitors (ICI) in patients with hepatitis C virus infection (HCV) has not been studied in many cancers as these patients were excluded from most ICI trials. This poses a degree of uncertainty when an HCV patient is being considered for ICI in the absence of data to inform potential adverse events (AEs). Methods : Single institution retrospective chart review of patients with active or resolved HCV who were treated with ICI for cancer of any type and stage from January 2012 – December 2019 with emphasis on AEs rates. Result : We identified 40 patients. Males 30 and females 10. Median age 64 years. Cancer types; non‐small cell lung cancer 18 (45%), hepatocellular carcinoma 12 (30%), head and neck cancer 4(10%), small cell lung cancer 3 (7.5%), renal cell carcinoma 1 (2.5%), colon cancer 1 (2.5%), and melanoma 1 (2.5%). Hepatitis C was untreated in 17 (42.5%), treated in 14 (35%), and spontaneously resolved in 9 (22.5%). AEs observed were; grade 3 pneumonitis in one patient (2.5%) on pembrolizumab, grade 3 colitis in one patient (2.5%) on nivolumab, two patients with hepatotoxicity (5%) on nivolumab; one patient with grade 1 and the other had grade 2, grade 1‐2 fatigue in 3 patients (7.5%), and one patient with hypothyroidism (2.5%). Conclusion : Adverse events rates in untreated and resolved HCV patients treated with ICI for a variety of cancers were comparable to AEs rates reported in clinical trials for patients without HCV. Implications for practice : The safety of immune checkpoint inhibitors (ICI) in cancer patients with hepatitis C virus infection is a major concern due to the lack of prospective safety data for most cancers. HCV is prevalent worldwide, and the occurrence of cancer where ICI is indicated is not uncommon. We retrospectively reviewed all HCV patients who received ICI for a variety of cancers in our institution over eight years, and the results are presented in this article. The results may help inform clinical decisions and the design of future clinical trials.
The Oncologist 2021