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Thibodeau S, Meem M, Hopman W, Sandhu S, Zalay O, Fung AS, Kartolo A, Digby GC, Al-Ghamdi S, Robinson A, Ashworth A, Owen T, Mahmud A, Tam K, Olding T, de Moraes FY. Survival outcomes and predicting intracranial metastasis in stage III non-small cell lung cancer treated with definitive chemoradiation: Real-world data from a tertiary cancer center. Cancer Treat Res Commun 2023; 36:100747. [PMID: 37531737 DOI: 10.1016/j.ctarc.2023.100747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE/OBJECTIVE Around 30% of patients with non-small cell lung cancers (NSCLC) are diagnosed with stage III disease at presentation, of which about 50% are treated with definitive chemoradiation (CRT). Around 65-80% of patients will eventually develop intracranial metastases (IM), though associated risk factors are not clearly described. We report survival outcomes and risk factors for development of IM in a cohort of patients with stage III NSCLC treated with CRT at a tertiary cancer center. MATERIALS/METHODS We identified 195 patients with stage III NSCLC treated with CRT from January 2010 to May 2021. Multivariable logistic regression was used to generate odds ratios for covariates associated with development of IM. Kaplan-Meier analysis with the Log Rank test was used for unadjusted time-to-event analyses. P-value for statistical significance was set at < 0.05 with a two-sided test. RESULTS Out of 195 patients, 108 (55.4%) had stage IIIA disease and 103 (52.8%) had adenocarcinoma histology. The median age and follow-up (in months) was 67 (IQR 60-74) and 21 (IQR 12-43), respectively. The dose of radiation was 60 Gy in 30 fractions for148 patients (75.9%). Of the 77 patients who received treatment since immunotherapy was available and standard at our cancer center, 45 (58.4%) received at least one cycle. During follow-up, 84 patients (43.1%) developed any metastasis, and 33 (16.9%) developed IM (either alone or with extracranial metastasis). 150 patients (76.9%) experienced a treatment delay (interval between diagnosis and treatment > 4 weeks). Factors associated with developing any metastasis included higher overall stage at diagnosis (p = 0.013) and higher prescribed dose (p = 0.022). Factors associated with developing IM included higher ratio of involved over sampled lymph nodes (p = 0.001) and receipt of pre-CRT systemic or radiotherapy for any reason (p = 0.034). On multivariate logistical regression, treatment delay (OR 3.9, p = 0.036) and overall stage at diagnosis (IIIA vs. IIIB/IIIC) (OR 2.8, p = 0.02) predicted development of IM. These findings were sustained on sensitivity analysis using different delay intervals. Median OS was not reached for the overall cohort, and was 43.1 months for patients with IM and 40.3 months in those with extracranial-only metastasis (p = 0.968). In patients with any metastasis, median OS was longer (p = 0.003) for those who experienced a treatment delay (48.4 months) compared to those that did not (12.2 months), likely due to expedited diagnosis and treatment in patients with a higher symptom burden secondary to more advanced disease. CONCLUSIONS In patients with stage III NSCLC treated with definitive CRT, the risk of IM appears to increase with overall stage at diagnosis and, importantly, may be associated with experiencing a treatment delay (> 4 weeks). Metastatic disease of any kind remains the primary life-limiting prognostic factor in these patients with advanced lung cancer. In patients with metastatic disease, treatment delay was associated with better survival. Patients who experience a treatment delay and those initially diagnosed at a more advanced overall stage may warrant more frequent surveillance for early diagnosis and treatment of IM. Healthcare system stakeholders should strive to mitigate treatment delay in patients with locally NSCLC to reduce the risk of IM. Further research is needed to better understand factors associated with survival, treatment delay, and the development of IM after CRT in the immunotherapy era.
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Affiliation(s)
- Stephane Thibodeau
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada; Faculty of Medicine, Queen's University, Ontario, Canada.
| | - Mahbuba Meem
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada; Faculty of Medicine, Queen's University, Ontario, Canada
| | - Wilma Hopman
- Faculty of Medicine, Queen's University, Ontario, Canada; Department of Public Health Sciences, Kingston Health Sciences Research Institute, Ontario, Canada
| | - Simran Sandhu
- Faculty of Medicine, Queen's University, Ontario, Canada
| | - Osbert Zalay
- Department of Radiology, Division of Radiation Oncology, Ottawa Hospital Cancer Centre, Ontario, Canada
| | - Andrea S Fung
- Faculty of Medicine, Queen's University, Ontario, Canada; Department of Oncology, Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada
| | - Adi Kartolo
- Department of Oncology, Division of Medical Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Ontario, Canada
| | - Geneviève C Digby
- Faculty of Medicine, Queen's University, Ontario, Canada; Department of Internal Medicine, Division of Respirology, Kingston Health Sciences Centre, Ontario, Canada
| | - Shahad Al-Ghamdi
- Faculty of Medicine, Queen's University, Ontario, Canada; Department of Internal Medicine, Division of Respirology, Kingston Health Sciences Centre, Ontario, Canada
| | - Andrew Robinson
- Faculty of Medicine, Queen's University, Ontario, Canada; Department of Oncology, Division of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada
| | - Allison Ashworth
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada; Faculty of Medicine, Queen's University, Ontario, Canada
| | - Timothy Owen
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada; Faculty of Medicine, Queen's University, Ontario, Canada
| | - Aamer Mahmud
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada; Faculty of Medicine, Queen's University, Ontario, Canada
| | - Kit Tam
- Department of Oncology, Division of Radiation Therapy, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada
| | - Timothy Olding
- Department of Oncology, Division of Medical Physics, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada
| | - Fabio Ynoe de Moraes
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Ontario, Canada; Faculty of Medicine, Queen's University, Ontario, Canada
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Yeung C, Meyers BM, Kartolo A. Management of metastatic head and neck Cancer: An all-in, kitchen-sink Approach? Oral Oncol 2023; 143:106444. [PMID: 37336178 DOI: 10.1016/j.oraloncology.2023.106444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/07/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Cynthia Yeung
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Brandon M Meyers
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Adi Kartolo
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
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3
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Yeung C, Kartolo A, Tong J, Hopman W, Baetz T. Association of circadian timing of initial infusions of immune checkpoint inhibitors with survival in advanced melanoma. Immunotherapy 2023. [PMID: 37191006 DOI: 10.2217/imt-2022-0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Aims: Chronomodulation of immune checkpoint inhibitors (ICIs) is not well understood. The authors evaluated the circadian timing of initial ICI infusions. Patients & methods: A retrospective cohort study of patients with advanced melanoma (n = 121) was conducted. Results: Exclusive afternoon timing of the first four infusions was associated with worse overall survival (5.5 vs 24.9 months; p < 0.001) and progression-free survival (3.3 vs 7.6 months; p = 0.009) on Kaplan-Meier curves. In multivariable Cox analysis, the rate of overall survival was lower in patients who received all first four ICI infusions in the afternoon versus patients who received ≥1 of the first four infusions in the morning (hazard ratio: 2.4; p = 0.004). Conclusion: Deliberate morning scheduling for the first several ICI treatments may improve patient-centered outcomes.
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Affiliation(s)
- Cynthia Yeung
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Adi Kartolo
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Justin Tong
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Wilma Hopman
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Tara Baetz
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
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4
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Kartolo A, Tong J, Yeung C, Kuksis M, Hopman W, Baetz T. Survivals following discontinuation of PD-1 inhibitor treatment in advanced melanoma patients. Melanoma Res 2023; 33:50-57. [PMID: 36382411 DOI: 10.1097/cmr.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate overall survival post-treatment discontinuation survival (OS PTD ) in advanced melanoma patients started on immunotherapy. This retrospective study included all unresectable advanced or metastatic melanoma patients who had permanent treatment discontinuation after receiving at least one cycle of palliative-intent programmed death-1 ± cytotoxic T-lymphocyte associated protein-4 inhibitor treatment from 2014 to 2019. Indications of permanent treatment discontinuation included treatment completion, toxicity or progression. OS PTD was defined as a time of permanent treatment discontinuation to the time of death. Our study ( N = 96) had 27, 12 and 57 patients who discontinued PD-1 inhibitor treatment due to treatment completion, toxicity and progression, respectively. Median treatment durations received for the treatment completion, toxicity and progression groups were 24, 6 and 3 months, respectively. As expected those patients who had disease progression on immunotherapy had very poor survival compared to those that completed treatment or stopped due to toxicity. A multivariable Cox model excluding the patients who progressed indicated no significant OS PTD differences between the toxicity and treatment completion group (HR, 0.894; 95% CI, 0.232-3.449; P = 0.871) who received single or dual immunotherapy. Our real-world study highlighted similar, durable survival at PD-1 inhibitor discontinuation due to either toxicity or treatment completion, despite longer treatment duration received in the completion group than toxicity group. Patients with progression on PD-1 inhibitor treatment have very poor survival. Our findings must be interpreted with caution due to its retrospective nature and small sample size.
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Affiliation(s)
- Adi Kartolo
- Department of Oncology, Queen's University, Kingston
- Department of Oncology, McMaster University, Hamilton
| | - Justin Tong
- Department of Oncology, Queen's University, Kingston
| | - Cynthia Yeung
- Department of Oncology, McMaster University, Hamilton
| | - Markus Kuksis
- Department of Oncology, McMaster University, Hamilton
| | | | - Tara Baetz
- Department of Oncology, Queen's University, Kingston
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5
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Kartolo A, Robinson A, Vera Badillo FE. Can Oncogenic Driver Alterations be Responsible for the Lack of Immunotherapy Efficacy in First-line Advanced Urothelial Carcinoma? Eur Urol 2023; 83:1-2. [PMID: 35606230 DOI: 10.1016/j.eururo.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022]
Abstract
Urothelial carcinoma (UC) harbors many oncogenic alterations and the limited efficacy of first-line immunotherapy in this setting suggests that oncogenic alterations could have potential as a predictive biomarker for treatment decision-making. Antibody-drug conjugates (ADCs) may offer new avenues for biomarker-driven treatment in advanced UC, especially for patients with oncogenic alterations.
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Affiliation(s)
- Adi Kartolo
- Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Andrew Robinson
- Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, ON, Canada
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6
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Kartolo A, Yeung C, Hopman W, Fung AS, Baetz T, Vera Badillo FE. Complete response and survival outcomes in patients with advanced cancer on immune checkpoint inhibitors. Immunotherapy 2022; 14:777-787. [PMID: 35678046 DOI: 10.2217/imt-2021-0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate overall survival in advanced cancer patients who achieved complete response (CR) with immune checkpoint inhibitor (ICI) therapy. Methods: This retrospective study included patients with advanced unresectable or metastatic cancer who received at least one cycle of palliative-intent ICI. Best overall response was used to define response groups. Results: 21 (7%) of 322 patients achieved CR. Multivariate analysis demonstrated that CR was independently associated with better overall survival compared with disease progression (hazard ratio: 0.012; 95% CI: 0.002-0.090) and stable disease (hazard ratio: 0.063; 95% CI: 0.009-0.464) as well as a nonsignificant trend toward better overall survival compared with partial response (hazard ratio: 0.169; 95% CI: 0.023-1.252) regardless of cancer type, ICI regimen or ICI line. Conclusion: Patients who achieved CR had longer survival compared with patients who did not achieve CR.
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Affiliation(s)
- Adi Kartolo
- Department of Oncology, Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Cynthia Yeung
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Kingston Health Sciences Centre, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Andrea S Fung
- Department of Oncology, Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Tara Baetz
- Department of Oncology, Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Francisco E Vera Badillo
- Department of Oncology, Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, K7L 3N6, Canada
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7
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Kartolo A, Tannock IF, Vera Badillo FE. Management of Metastatic Hormone-Sensitive Prostate Cancer: Is Docetaxel Needed? J Clin Oncol 2022; 40:3573-3575. [PMID: 35724342 DOI: 10.1200/jco.22.00705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Adi Kartolo
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Ontario, Canada
| | - Ian F Tannock
- Department of Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Francisco E Vera Badillo
- Department of Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Ontario, Canada
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8
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Yeung C, Kartolo A, Holstead R, Moffat GT, Hanna L, Hopman W, Baetz T. No association between BMI and immunotoxicity or clinical outcomes for immune checkpoint inhibitors. Immunotherapy 2022; 14:765-776. [PMID: 35695057 DOI: 10.2217/imt-2021-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The impact of BMI on immune checkpoint inhibitor toxicity and efficacy has not been clearly characterized. Methods: The authors conducted a retrospective single-center study of patients with advanced unresectable/metastatic cancer initiated on immune checkpoint inhibitors. Results: Of the 409 patients included in the study, 115 (28%) had a BMI ≥30. There was no difference in the development of immune-related adverse events, treatment response or overall survival with respect to BMI <30 versus ≥30 for the whole study population or the melanoma subgroup. Conclusion: Patients with BMI in the obese range (≥30) were not at increased risk of immunotoxicity. Furthermore, BMI was not correlated with treatment response or overall survival in patients receiving immune checkpoint inhibitors.
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Affiliation(s)
- Cynthia Yeung
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
| | - Adi Kartolo
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
| | - Ryan Holstead
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
| | - Gordon Taylor Moffat
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
| | - Lilian Hanna
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
| | - Wilma Hopman
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
| | - Tara Baetz
- Department of Oncology, Kingston Health Sciences Centre, Kingston, ON, K7L 2V7, Canada
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9
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Kartolo A, Yeung C, Kuksis M, Hopman W, Baetz T. Improved overall survival in dual compared to single immune checkpoint inhibitors in BRAF V600-negative advanced melanoma. Melanoma Manag 2022; 9:MMT60. [PMID: 35497071 PMCID: PMC9043874 DOI: 10.2217/mmt-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: To evaluate the efficacy of dual versus single immune checkpoint inhibitors (ICI) in BRAF wild-type advanced melanoma patients. Materials & methods: A retrospective study of all advanced BRAF wild-type melanoma patients on palliative-intent ICI between 2015 and 2020 (n = 67). Results: Dual ICI had better overall survival (OS) when compared with single ICI in BRAF wild-type patients (hazard ratio: 0.204; 95% CI: 0.064–0.649; p = 0.007), but lost its statistical significance (median OSl not reached vs 20.9 months; p = 0.213; adjusted hazard ratio: 0.475; 95% CI: 0.164–1.380; p = 0.171) when only including patients treated after 2018 when dual ICI was funded in our province. Dual ICI were significantly associated with more frequent (p = 0.005) and severe (p = 0.026) immune-related adverse events, and required more immune-related adverse events-indicated systemic corticosteroid use (p < 0.001) compared with single ICI. Conclusion: While limited by small sample size and retrospective nature, dual ICI may have non statistically significant trend toward better OS efficacy when compared with single ICI in BRAF V600 wild-type advanced melanoma patients.
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Affiliation(s)
- Adi Kartolo
- Cancer Centre of SouthEastern Ontario, Kingston Health Sciences Centre, Queen’s University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Cynthia Yeung
- Cancer Centre of SouthEastern Ontario, Kingston Health Sciences Centre, Queen’s University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Markus Kuksis
- Cancer Centre of SouthEastern Ontario, Kingston Health Sciences Centre, Queen’s University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Wilma Hopman
- Cancer Centre of SouthEastern Ontario, Kingston Health Sciences Centre, Queen’s University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Tara Baetz
- Cancer Centre of SouthEastern Ontario, Kingston Health Sciences Centre, Queen’s University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
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10
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Kartolo A, Deluce J, Hopman WM, Liu L, Baetz T, Ernst S, Lenehan JG. Real-World Evidence of Systemic Therapy Sequencing on Overall Survival for Patients with Metastatic BRAF-Mutated Cutaneous Melanoma. Curr Oncol 2022; 29:1501-1513. [PMID: 35323326 PMCID: PMC8947206 DOI: 10.3390/curroncol29030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Aim: To evaluate optimal systemic therapy sequencing (first-line targeted therapy (1L-TT) vs. first-line immunotherapy (1L-IO)) in patients with BRAF-mutated metastatic melanoma. Methods: Nation-wide prospective data of patients with newly diagnosed BRAF-mutated metastatic melanoma were retrieved from the Canadian Melanoma Research Network. Results: Our study included 79 and 107 patients in the 1L-IO and 1L-TT groups, respectively. There were more patients with ECOG 0−1 (91% vs. 72%, p = 0.023) in the 1L-IO group compared to the 1L-TT group. Multivariable Cox analysis suggested no OS differences between the two groups (HR 0.838, 95%CI 0.502−1.400, p = 0.500). However, patients who received 1L-TT then 2L-IO had the longest OS compared to 1L-IO without 2L therapy, 1L-IO then 2L-TT, and 1L-TT without 2L therapy (38.3 vs. 32.2 vs. 16.9 vs. 6.3 months, p < 0.001). For patients who received 2L therapy, those who received 2L-IO had a trend towards OS improvement compared with the 2L-TT group (21.7 vs. 8.9 months, p = 0.053). Conclusions: Our nation-wide prospective study failed to establish any optimal systemic therapy sequencing in advanced BRAF-mutant melanoma patients. Nevertheless, we provided evidence that immunotherapy has durable efficacy in advanced BRAF-mutant melanoma patients, regardless of treatment line, and that Canadian medical oncologists were selecting the appropriate treatment sequences in a real-world setting, based on patients’ clinical and tumour characteristics.
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Affiliation(s)
- Adi Kartolo
- Department of Oncology, Queen’s University, Kingston, ON K7L 2V7, Canada; (A.K.); (T.B.)
| | - Jasna Deluce
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada; (J.D.); (S.E.)
| | - Wilma M. Hopman
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada;
| | - Linda Liu
- Pulse Infoframe, London, ON N5X 4E7, Canada;
| | - Tara Baetz
- Department of Oncology, Queen’s University, Kingston, ON K7L 2V7, Canada; (A.K.); (T.B.)
| | - Scott Ernst
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada; (J.D.); (S.E.)
| | - John G. Lenehan
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada; (J.D.); (S.E.)
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Affiliation(s)
- Adi Kartolo
- Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Andrew Robinson
- Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Andrea S Fung
- Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, ON, K7L 3N6, Canada
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12
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Kartolo A, Yeung C, Moffat GT, Hanna L, Hopman W, Baetz T. Venous thromboembolism events in patients with advanced cancer on immune checkpoint inhibitors. Immunotherapy 2021; 14:23-30. [PMID: 34758641 DOI: 10.2217/imt-2021-0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To evaluate the correlation between venous thromboembolism events (VTEs) and immune checkpoint inhibitor (ICI)-based regimens. Methods: This is a retrospective study of 403 patients with advanced cancer on ICI-based regimens. Results: We report 8% VTE incidence post-ICI initiation over a median of 11.1 months of follow-up. Compared with single-agent ICI, dual-ICI was significantly correlated with higher incidence of VTE (odds ratio [OR]: 4.196, 95% CI: 1.527-11.529, p = 0.005), but chemotherapy-immuno-oncology combination was not (OR: 1.374, 95% CI: 0.285-6.632, p = 0.693). Subsequent systemic therapy post-ICI was also independently associated with higher VTE incidence (OR: 2.599, 95% CI: 1.169-5.777, p = 0.019). Conclusion: Our findings suggest potential underreporting of VTE incidence in ICI clinical trials. As dual-ICI is becoming more prevalent in cancer management, clinicians should maintain vigilance regarding VTE in patients with advanced cancer on ICI-based regimens.
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Affiliation(s)
- Adi Kartolo
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Cynthia Yeung
- Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Internal Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gordon T Moffat
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Lilian Hanna
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tara Baetz
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
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Yeung C, Kartolo A, Holstead R, Moffat GT, Hanna L, Hopman W, Lakoff J, Baetz T. Safety and Clinical Outcomes of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Diseases. J Immunother 2021; 44:362-370. [PMID: 34121061 DOI: 10.1097/cji.0000000000000377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 11/27/2022]
Abstract
Immunotherapy has revolutionized treatment outcomes in numerous cancers. However, clinical trials have largely excluded patients with autoimmune diseases (ADs) due to the risk of AD flares or predilection for developing organ-specific inflammation. The objective of this study was to evaluate the safety and efficacy of immunotherapy in patients with cancer and preexisting ADs. A retrospective, single-center study of patients with cancer initiated on immune checkpoint inhibitors between 2012 and 2019 was conducted. The primary outcome was the development of immune-related adverse events (irAEs) with respect to the presence of AD at baseline. Associations were assessed using Kaplan-Meier curves, bivariate and multivariable analyses. Of the 417 patients included in this study, 63 patients (15%) had preexisting ADs. A total of 218 patients (53%) developed at least 1 irAE. There was no association between the presence of baseline AD on the development, grade, or number of irAEs; time to irAE or irAE recovery; systemic corticosteroid or additional immunosuppressant treatment for irAEs; permanent treatment discontinuation; or overall response rate. Two smaller cohorts were studied, melanoma and non-small cell lung cancer, and there was no effect of baseline AD on overall survival on either cohort. However, a greater proportion of patients with baseline ADs had full recovery from their irAE (P=0.037). Furthermore, age below 65, baseline steroid use, and single-agent immunotherapy regimens were protective in terms of the development of irAEs. Our study suggests that immune checkpoint inhibitors have similar safety and efficacy profiles in patients with preexisting ADs.
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Affiliation(s)
- Cynthia Yeung
- Kingston Health Sciences Centre, Kingston, ON, Canada
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Kartolo A, Kassouf W, Vera-Badillo FE. Adjuvant Immune Checkpoint Inhibition in Muscle-invasive Bladder Cancer: Is It Ready for Prime Time? Eur Urol 2021; 80:679-681. [PMID: 34366212 DOI: 10.1016/j.eururo.2021.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
Abstract
We discuss results from the Checkmate-274 and IMvigor010 trials on adjuvant immune checkpoint inhibitor (ICI) therapy in muscle-invasive bladder cancer (MIBC) with or without neoadjuvant chemotherapy (NAC), and conclude that adjuvant ICI (nivolumab but not atezolizumab) should be considered for patients with resected high-risk MIBC, especially for those who have received NAC.
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Affiliation(s)
- Adi Kartolo
- Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, Canada
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Canada
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15
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Kartolo A, Procopio G, Vera-Badillo FE. Management of Favorable-risk Advanced Renal Cell Carcinoma: Is Dual Therapy the Answer? EUR UROL SUPPL 2021; 30:44-46. [PMID: 34337547 PMCID: PMC8317808 DOI: 10.1016/j.euros.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Adi Kartolo
- Division of Medical Oncology, Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Giuseppe Procopio
- Dipartimento di Oncologia Medica, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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16
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Kartolo A, Towheed T, Mates M. A case of successful pembrolizumab rechallenge in a patient with non-small-cell lung cancer and grade 3 dermatomyositis. Immunotherapy 2021; 13:477-481. [PMID: 33626928 DOI: 10.2217/imt-2020-0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report a case of dermatomyositis in a 59-year old female with advanced non-small-cell lung cancer post one cycle of first-line pembrolizumab monotherapy. Her symptoms resolved with high-dose methyl-prednisolone and subsequent prolonged oral prednisone taper over 11 weeks. She achieved durable response over 6 months without further pembrolizumab and was successfully rechallenged without recurrent high-grade immunotoxicity. To our knowledge, this is the only case of severe immune-related dermatomyositis successfully rechallenged with immunotherapy. In this case report, we highlight that dermatomyositis remains a clinical diagnosis with no reliable autoimmune antibody marker. It is a rare immune-related adverse event for which clinicians must remain highly vigilant. We also discuss the rationale and clinical factors to consider on immunotherapy rechallenge decisions.
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Affiliation(s)
- Adi Kartolo
- Department of Medical Oncology, Queen's University, Kingston K7L 2V7, Canada.,Kingston Health Sciences Centre, Kingston Ontario, Kingston K7L 2V7, Canada
| | - Tanveer Towheed
- Kingston Health Sciences Centre, Kingston Ontario, Kingston K7L 2V7, Canada.,Department of Medicine, Queen's University, Kingston K7L 2V7, Canada
| | - Mihaela Mates
- Department of Medical Oncology, Queen's University, Kingston K7L 2V7, Canada.,Kingston Health Sciences Centre, Kingston Ontario, Kingston K7L 2V7, Canada
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Kartolo A, Feilotter H, Hopman W, Fung AS, Robinson A. A single institution study evaluating outcomes of PD-L1 high KRAS-mutant advanced non-small cell lung cancer (NSCLC) patients treated with first line immune checkpoint inhibitors. Cancer Treat Res Commun 2021; 27:100330. [PMID: 33581492 DOI: 10.1016/j.ctarc.2021.100330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
AIM This study aimed to evaluate the impact of KRAS status on the efficacy of first-line immune checkpoint inhibitors (ICI) in patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Patients with advanced incurable or metastatic NSCLC with PD-L1 ≥50% treated with palliative-intent, single-agent PD-1/PD-L1 inhibitors at the Cancer Centre of Southeastern Ontario were included. KRAS mutation status was determined via massively parallel sequencing. Primary study outcome was median overall survival (mOS). RESULTS Seventy-eight patients (59 non-squamous, 19 squamous) were identified; only non-squamous patients were included in KRAS mutation analyses. Thirty patients (51%) were KRAS-MT (mutant), with G12C (19%), G12V (15%), and G12D (13%) accounting for the most common KRAS mutation subtypes. There was no difference in mOS between KRAS-MT and KRAS-WT (wild-type) patients (12.9 vs. 19.3 months, p = 0.879). There was a non-significant trend towards worse mOS in KRAS G12C patients compared to non-G12C and KRAS-WT patients (11.4 vs. 44.9 vs. 19.3 months, p = 0.772). On multivariable analysis, KRAS-MT status was not associated with mOS (HR 0.901, 95%CI 0.417-1.946, p = 0.791). ECOG≥2 was an independent prognostic factor for worse mOS (HR 2.853, 95%CI 1.237-6.583, p = 0.014). Immune-related adverse events did not differ between KRAS-MT and KRAS-WT groups (48% vs. 52%, p = 1.000). CONCLUSIONS KRAS mutation status did not have a significant impact on ICI efficacy or safety. However, a non-significant trend towards worse survival was noted in patients treated with ICI whose tumours harboured the KRAS G12C variant. This study provides valuable information for comparative analysis in the future.
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Affiliation(s)
- Adi Kartolo
- Cancer Centre of Southeastern Ontario, Canada; Kingston Health Sciences Centre, Canada; Department of Medical Oncology, Queen's University, Canada.
| | - Harriet Feilotter
- Kingston Health Sciences Centre, Canada; Department of Pathology and Molecular Medicine, Queen's University, Canada
| | - Wilma Hopman
- Kingston Health Sciences Centre, Canada; Department of Public Health Sciences, Queen's University, Canada
| | - Andrea S Fung
- Cancer Centre of Southeastern Ontario, Canada; Kingston Health Sciences Centre, Canada; Department of Medical Oncology, Queen's University, Canada
| | - Andrew Robinson
- Cancer Centre of Southeastern Ontario, Canada; Kingston Health Sciences Centre, Canada; Department of Medical Oncology, Queen's University, Canada.
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18
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Kartolo A, Holstead R, Hopman W, Young L, Baetz T. Safety and efficacy analysis of pembrolizumab dosing patterns in patients with advanced melanoma and non-small cell lung cancer. J Oncol Pharm Pract 2021; 28:87-95. [PMID: 33509058 DOI: 10.1177/1078155220984252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the impact of discrepancy between prescribed and recommended fixed 200 mg dose (P-F discrepancy) on immune-related adverse events (irAEs) and treatment efficacy in patients with advanced melanoma and NSCLC. METHODS This retrospective study included 177 patients with advanced melanoma or non-small cell lung cancer (NSCLC) who received at least one cycle of single-agent pembrolizumab. We defined P-F discrepancy as the differences between prescribed pembrolizumab dose and 200 mg recommended dose, expressed in percentages. Our primary outcome was immune-related adverse events (irAEs), and our secondary outcomes included overall survival (OS) and progression free survival (PFS). RESULTS The median P-F discrepancy was -21.5%, with the 25th and 75th percentile at -32% and -5.0% respectively. ROC curve analyses did not show any optimal cutoffs to prognosticate irAEs (AUC = 0.558 for all patients) or cancer mortality (AUC = 0.583 for melanoma; AUC = 0.539 for NSCLC) in either cancer type. Separate multivariable Cox analyses suggested no statistically significant association between P-F discrepancy and overall survival in patients with melanoma (HR 1.012, 95%CI 0.987-1.038, P = 0.362) or NSCLC (HR 0.998, 95%CI 0.978-1.019, P = 0.876). CONCLUSION There was no optimal pembrolizumab cut-off point to predict irAEs or treatment efficacy. We supported the use of weight-based pembrolizumab dosing, given the potential cost-saving and no differences in terms of irAEs or treatment efficacy in patients with advanced melanoma or NSCLC. Future studies on province- or national-level would be important to validate our findings.
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Affiliation(s)
- A Kartolo
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - R Holstead
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - W Hopman
- Queen's University, Kingston, ON, Canada
| | - L Young
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - T Baetz
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
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19
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Kartolo A, Holstead R, Khalid S, Emack J, Hopman W, Baetz T. Safety of Immunotherapy Rechallenge After Immune-related Adverse Events in Patients With Advanced Cancer. J Immunother 2021; 44:41-48. [PMID: 32815895 DOI: 10.1097/cji.0000000000000337] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This retrospective study aimed to investigate the safety profile of continuing or rechallenging patients with advanced cancer who developed grade≥2 immune-related adverse events (irAEs) on immunotherapy-based regimens. Our study had 25, 20, and 40 patients (N=85) in the Treatment Continuation (TCG), Non-Rechallenge (NRG), and Rechallenge Groups (RG), respectively. Subsequent irAEs recurrence were more common in RG than TCG and NRG (78% vs. 56% vs. 25%, P<0.001). The same subsequent irAEs recurrences occurred on 42% of RG, 4% of TCG, and 15% of NRG (P<0.001). On the RG, there was a nonstatistical trend of shortening interval time between time from treatment rechallenge to subsequent irAEs when compared with time from first treatment to initial grade≥2 irAEs (5.86 vs. 8.86 wk, P=0.114). Patients who had cardiac irAEs were not rechallenged. Several high-risk features were identified to prognosticate risk of irAEs recurrences upon treatment rechallenge, including age 65 years and above (P=0.007), programmed cell death protein 1 inhibitors (P<0.001), grade 3 irAEs (P=0.003), pneumonitis type (P=0.048), any systemic corticosteroid use (P=0.001)/high-dose systemic corticosteroid use (P=0.007)/prolonged ≥4-week corticosteroid use (P=0.001) for irAEs management, and early development of irAEs (P=0.003). Our study concluded that it was relatively safe to continue or rechallenge patients with advanced cancers on immunotherapy-based regimens postdevelopment of certain grade≥2 irAEs, except for cardiac, neurological, or any grade 4 irAEs. Subsequent irAEs were common, no more severe, involved the same organ sites, and occurred more quickly than the original irAE. Close monitoring of all potential irAEs is required when rechallenging a patient on immunotherapy, especially for patients with high-risk features.
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Affiliation(s)
- Adi Kartolo
- Cancer Care of Southeastern Ontario
- Queens' University, Kingston, ON, Canada
| | - Ryan Holstead
- Cancer Care of Southeastern Ontario
- Queens' University, Kingston, ON, Canada
| | - Sidra Khalid
- Cancer Care of Southeastern Ontario
- Queens' University, Kingston, ON, Canada
| | - Jeffrey Emack
- Cancer Care of Southeastern Ontario
- Queens' University, Kingston, ON, Canada
| | | | - Tara Baetz
- Cancer Care of Southeastern Ontario
- Queens' University, Kingston, ON, Canada
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20
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Holstead R, Kartolo A, Baetz T. Emergency Department Utilization for Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Analysis of Identification and Outcomes for Those Presenting for Immune-Related Adverse Events. Curr Oncol 2020; 28:52-59. [PMID: 33704174 PMCID: PMC7816173 DOI: 10.3390/curroncol28010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Immune-related adverse events (iRAEs) are known complications of immune checkpoint inhibitors (ICIs). Early identification and management leads to improved morbidity and mortality. This study seeks to address our center's experience with iRAEs in the emergency department (ED). METHODS We performed a retrospective review of patients treated with ICIs in 2018 and 2019 for any indication. All diagnoses of iRAEs were recorded. For all patients who presented to the ED following administration of an ICI, we assessed whether the presenting symptoms were eventually diagnosed as an iRAE. We assessed disposition, time to initiation of corticosteroids and outcomes in these patients. RESULTS 351 evaluable patients were treated with an ICI, 129 patients (37%) had at least one presentation to the ED, 17 of whom presented with symptoms due to a new iRAE. New iRAE diagnoses were broad, occurred after median 2 cycles, majority irAEs were grade 3 or higher (70.6%), and two patients died due to toxicity. Twelve patients were admitted to the hospital during initial presentation or at follow-up, four required ICU care. All patients required immunosuppressive therapy, and only three were later re-challenged with an ICI. Of the patients who were admitted to the hospital, median time to first dose of corticosteroid was 30.5 h (range 1-269 h). CONCLUSIONS Patients on ICI have a significant risk of requiring an ED visit. A notable proportion of iRAEs have their first presentation at the ED and often can present in a very nonspecific manner. A standardized approach in the ED at the time of presentation may lead to improved identification and management of these patients.
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Affiliation(s)
| | | | - Tara Baetz
- Cancer Centre of Southeastern Ontario, Department of Oncology, Queen’s University, Kingston, ON K7L 2V7, Canada; (R.H.); (A.K.)
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21
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Kartolo A, Holstead R, Hopman W, Baetz T. Prognosticating role of serum eosinophils on immunotherapy efficacy in patients with advanced melanoma. Immunotherapy 2020; 13:217-225. [PMID: 33238773 DOI: 10.2217/imt-2020-0265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: To evaluate serum eosinophilia (≥500 peripheral eosinophil counts/microliter) in prognosticating immunotherapy (IO) efficacy. Methodology: A retrospective study of 86 patients with advanced melanoma on PD-1 inhibitors. Results: Eosinophilia-on-IO was an independent prognosticating factor for median OS (HR :0.223; 95% CI: 0.088-0.567; p = 0.002). 'Late eosinophilia' (≥1 year from IO start date) group had better median OS (31.9 vs 24.1 vs 13.0 months; p = 0.002) when compared with 'early eosinophilia' (<1 year from IO start date) and 'no eosinophilia' groups, respectively. Conclusion: Eosinophilia-on-IO and its timing were associated with better IO efficacy in patients with advanced melanoma. Our findings provided insights on potential therapeutic benefit of inducing eosinophilia at certain interval time to obtain a longer durable immunotherapy response.
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Affiliation(s)
- Adi Kartolo
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Ryan Holstead
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Wilma Hopman
- Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Tara Baetz
- Department of Medical Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
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22
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Kartolo A, Holstead R, Khalid S, Emack J, Hopman W, Robinson A, Baetz T. Serum neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in prognosticating immunotherapy efficacy. Immunotherapy 2020; 12:785-798. [PMID: 32657234 DOI: 10.2217/imt-2020-0105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To examine neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in prognosticating immunotherapy efficacy. Methods: A retrospective study of 156 patients with metastatic melanoma and non-small-cell lung cancer on PD-1 inhibitors. Results: Baseline NLR ≥5 was associated with worse progression-free survival (hazard ratio [HR]: 1.53; 95% CI: 1.01-2.31; p = 0.043) but nonsignificant worse overall survival trend (HR: 1.51; 95% CI: 0.98-2.34; p = 0.064). PLR ≥200 was associated with worse overall survival (HR: 1.94; 95% CI: 1.29-2.94; p = 0.002) and worse progression-free survival (HR: 1.894; 95% CI: 1.27-2.82; p = 0.002). NLR or PLR are prognosticating factors regardless of cancer types, with PLR having a stronger association with outcomes than NLR. Conclusion: High baseline NLR or PLR (alone and combined) were associated with worse immunotherapy efficacy regardless of cancer type, indicating their potential role as an agnostic marker for immunotherapy efficacy.
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Affiliation(s)
- Adi Kartolo
- Cancer Care of Southeastern Ontario, Department of Medical Oncology, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Ryan Holstead
- Cancer Care of Southeastern Ontario, Department of Medical Oncology, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Sidra Khalid
- Cancer Care of Southeastern Ontario, Department of Medical Oncology, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Jeffrey Emack
- Cancer Care of Southeastern Ontario, Department of Medical Oncology, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Wilma Hopman
- Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Andrew Robinson
- Cancer Care of Southeastern Ontario, Department of Medical Oncology, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
| | - Tara Baetz
- Cancer Care of Southeastern Ontario, Department of Medical Oncology, Kingston, Ontario K7L 2V7, Canada.,Queen's University, Kingston, Ontario K7L 2V7, Canada
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Kartolo A, Robinson A. Correlation between different carboplatin dosing patterns and its toxicity analysis in patients with advanced lung cancers: A retrospective study. J Oncol Pharm Pract 2019; 25:1082-1088. [DOI: 10.1177/1078155218773548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adi Kartolo
- Department of Internal Medicine, Queens' University, Kingston, Ontario
| | - Andrew Robinson
- Department of Medical Oncology, Queens' University, Kingston, Ontario
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24
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Abstract
Purpose We aimed to elucidate predictive factors for the development of immune-related adverse events (iraes) in patients receiving immunotherapies for the management of advanced solid cancers. Methods This retrospective study involved all patients with histologically confirmed metastatic or inoperable melanoma, non-small-cell lung cancer, or renal cell carcinoma receiving immunotherapy at the Cancer Centre of Southeastern Ontario. The type and severity of iraes, as well as potential protective and exacerbating factors, were collected from patient charts. Results The study included 78 patients receiving ipilimumab (32%), nivolumab (33%), or pembrolizumab (35%). Melanoma, non-small-cell lung cancer, and renal cell carcinoma accounted for 70%, 22%, and 8% of the cancers in the study population. In 41 patients (53%) iraes developed, with multiple iraes developing in 12 patients (15%). In most patients (70%), the iraes were of severity grade 1 or 2. Female sex [adjusted odds ratio (oradj): 0.094; 95% confidence interval (ci): 0.021 to 0.415; p = 0.002] and corticosteroid use before immunotherapy (oradj: 0.143; 95% ci: 0.036 to 0.562; p = 0.005) were found to be associated with a protective effect against iraes. In contrast, a history of autoimmune disease (oradj: 9.55; 95% ci: 1.34 to 68.22; p = 0.025), use of ctla-4 inhibitors (oradj: 6.25; 95% ci: 1.61 to 24.25; p = 0.008), and poor kidney function of grade 3 or greater (oradj: 10.66; 95% ci: 2.41 to 47.12; p = 0.025) were associated with a higher risk of developing iraes. A Hosmer-Lemeshow goodness-of-fit test demonstrated that the logistic regression model was effective at predicting the development of iraes (chi-square: 1.596; df = 7; p = 0.979). Conclusions Our study highlights several factors that affect the development of iraes in patients receiving immunotherapy. Although future studies are needed to validate the resulting model, findings from the study can help to guide risk stratification, monitoring, and management of iraes in patients given immunotherapy for advanced cancer.
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Affiliation(s)
- A Kartolo
- Department of Medicine, Queen's University, Kingston, ON
| | - J Sattar
- Department of Medicine, Queen's University, Kingston, ON
| | - V Sahai
- Hotel Dieu Hospital, Kingston, ON
| | - T Baetz
- Department of Medicine, Queen's University, Kingston, ON.,Cancer Centre of Southeastern Ontario, Kingston, ON
| | - J M Lakoff
- Department of Medicine, Queen's University, Kingston, ON.,Hotel Dieu Hospital, Kingston, ON.,Department of Endocrinology, Queen's University, Kingston, ON
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25
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Sattar J, Kartolo A, Hopman WM, Lakoff JM, Baetz T. The efficacy and toxicity of immune checkpoint inhibitors in a real-world older patient population. J Geriatr Oncol 2018; 10:411-414. [PMID: 30104155 DOI: 10.1016/j.jgo.2018.07.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/22/2018] [Accepted: 07/30/2018] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Immunotherapy has emerged as an effective treatment option for the management of advanced cancers. The effects of these immune checkpoint inhibitors in the older patient population has not been adequately assessed. OBJECTIVE To understand the impact of aging on CTLA-4 and PDL-1 inhibitors efficacy and immune-related adverse events (irAE) in the context of real-world management of advanced solid cancers. DESIGN, SETTING, AND PARTICIPANTS This retrospective study involved all non-study patients with histologically-confirmed metastatic or inoperable solid cancers receiving immunotherapy at Kingston Health Sciences Centre. We defined 'older patient' as age ≥ 75. All statistical analyses were conducted under SPSS IBM for Windows version 24.0. MAIN OUTCOMES AND MEASURES Study outcomes included immunotherapy treatment response, survival, as well as number, type, and severity of irAEs. RESULTS Our study (N = 78) had 29 (37%) patients age <65, 26 (33%) patients age 65-74, and 23 (30%) patients age ≥75. Melanoma, non-small cell lung cancer, and renal cell carcinoma accounted for 70%, 22%, and 8% of the study population, respectively. Distributions of ipilimumab (32%), nivolumab (33%), and pembrolizumab (35%) were similar in the study. The response rates were 28%, 27%, and 39% in the age <65, age 64-74, age ≥75 groups, respectively (P = 0.585). Kaplan-Meier curve showed a median survival of 28 months (12.28-43.9, 95% CI) and 17 months (0-36.9, 95% CI) in the age <65 and age 64-74 groups, respectively; the estimated survival probability did not reach 50% in the age ≥75 group (P = 0.319). There were no statistically significant differences found in terms of irAEs, multiple irAEs, severity of grade 3 or higher, types of irAEs, and irAEs resolution status when comparing between different age groups. CONCLUSION AND RELEVANCE Our results suggest that patients age ≥75 are able to gain as much benefit from immunotherapy as younger patients, without excess toxicity. Our findings suggest that single agent immunotherapy is generally well-tolerated across different age groups with no significant difference in the type, frequency or severity of irAEs. Future studies evaluating aging and combination immunotherapy are warranted.
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Affiliation(s)
- Joobin Sattar
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adi Kartolo
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Kingston General Health Research Institute, and Department of Public Health Sciences, Kingston, Ontario, Canada
| | - Joshua Matthew Lakoff
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Endocrinology, Kingston, Ontario, Canada
| | - Tara Baetz
- Department of Medicine, Queen's University, Kingston, Ontario, Canada; Kingston General Health Research Institute, and Department of Public Health Sciences, Kingston, Ontario, Canada; Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada.
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26
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Brown K, Commandant M, Kartolo A, Rowed C, Stanek A, Sultan H, Toor K, Wininger V. Case Based Learning Teaching Methodology in Undergraduate Health Sciences. Interdiscip Sci 2012. [DOI: 10.18192/riss-ijhs.v2i2.1521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Case-based learning (CBL) is an interactive teaching approach involving small-group discussion to determine a range of solutions for a presented patient case. In light of the success that the approach has achieved in numerous professional and undergraduate programs, a pilot project was introduced in 2009 by senior health sciences students, who acted as CBL facilitators, at the University of Ottawa for undergraduate courses in the Interdisciplinary School of Health Sciences (ISHS). In collaboration with faculty professors, the facilitators developed CBL sessions consisting of patient cases that were reflective of the core objectives of health sciences courses. A total of 144 undergraduate students from three ISHS courses took part in these sessions; they were evaluated based on the calibre of their participation and a quiz. The quiz consisted of 5 questions that evaluated the students’ mastery of the concepts covered in the CBL session. The students also completed an evaluation of the pilot project. On a nominal scale of one to five, the students on average scored 4.13 out of a possible 5.00 (SD 1.48) marks on the quiz. In the evaluation, the students rated the project as having an overall learning benefit of 3.82 on a nominal scale of one to four. The evaluation indicates that the students perceived the program as having significant learning value and the quiz marks confirmed that CBL promoted the application of lecture content to practical scenarios. These preliminary findings suggest that implementing CBL in ISHS would enhance students’ academic experience. Further sessions based on this model would improve from more rigorous pre- and post- session assessments.
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