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Fujimoto N, Akamatsu A, Honda C, Aoki M, Ohe Y. Real-world safety of nivolumab in patients with malignant pleural mesothelioma in Japan: post-marketing surveillance study. Jpn J Clin Oncol 2024:hyae119. [PMID: 39225432 DOI: 10.1093/jjco/hyae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE This post-marketing surveillance (PMS) was conducted to evaluate the incidence of adverse events with nivolumab in patients with unresectable, advanced or recurrent malignant pleural mesothelioma (MPM) that had progressed after first-line chemotherapy and to identify factors that potentially affected its safety in real-world clinical practice. METHODS Patients who had not received nivolumab previously were registered between November 2018 and February 2021. Nivolumab was given intravenously 240 mg every 2 weeks or 480 mg every 4 weeks. Patients were followed up for 6 months after treatment initiation. Information on patient characteristics, treatment status, and adverse events was collected. RESULTS This PMS enrolled 124 patients, involving 48 sites across Japan. At 6 months, nivolumab therapy was ongoing in 35.5% of patients (44/124) and had been discontinued in 64.5% (80/124). The overall incidence of treatment-related adverse events (TRAEs) was 40.3%; the incidence of Grade 3 or higher TRAEs was 12.9%. The pattern of TRAEs based on System Organ Class categories was generally consistent with those seen in the Japanese phase II MERIT study. The most common Grade 3 or higher TRAEs were interstitial lung disease (2.4%), lung disorder, and diarrhea (each 1.6%). The incidence of TRAEs was significantly higher in inpatients or patients who had good PS, high bodyweight, high body mass index, or autoimmune diseases than in those without these characteristics. CONCLUSION The post-marketing incidence of TRAEs with nivolumab in patients with MPM has been evaluated, and no new safety signals were identified compared to the phase II clinical trial in Japan.
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Affiliation(s)
- Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Ayumi Akamatsu
- Pharmacovigilance Division, Ono Pharmaceutical, Osaka, Japan
| | - Chikara Honda
- Pharmacovigilance Division, Ono Pharmaceutical, Osaka, Japan
| | - Miki Aoki
- Pharmacovigilance Division, Ono Pharmaceutical, Osaka, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Matsuo M, Masuda M, Yamauchi M, Hashimoto K, Kogo R, Sato M, Masuda S, Nakagawa T. Progression-Free Survival and Treatment-Free Interval in Head and Neck Cancer with Long-Term Response to Nivolumab: Timing of Active Discontinuation. Cancers (Basel) 2024; 16:2527. [PMID: 39061167 PMCID: PMC11274866 DOI: 10.3390/cancers16142527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
The optimal timing for actively discontinuing immune checkpoint inhibitor therapy in long-term responders with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) remains unresolved. We conducted a retrospective study of 246 patients with R/M HNSCC treated with nivolumab to determine the optimal timing to actively discontinue nivolumab therapy. We examined the point at which progression-free survival (PFS) plateaued in all cases. We compared the prognosis of 19 (7.7%) ongoing cases and 227 (92.3%) discontinued cases and analyzed treatment duration and treatment-free interval (TFI). The 6-year overall survival was 11.8% (median, 12.1), and the 6-year PFS was 15.3% (median, 3.0). The PFS curve remained stable for 3 years. The median duration of nivolumab treatment was 2.9 months (range 0.03-81.9): Ongoing group, 41.8 (5.6-81.9); Decision group, 36.8 (4.0-70.1); Toxicity group, 30.6 (2.8-64.8); and progressive disease group, 2.0 (0.03-42.9). TFI in the Decision group was 15.1 months (0.6-61.6) and 30.6 months (2.8-64.8) in the Toxicity group. Long-term responses in R/M HNSCC patients treated with nivolumab are rare but gradually increasing. For this patient group, our best estimate of the optimal time to end treatment is 3 years, as the PFS in this study reached a plateau at that timepoint.
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Affiliation(s)
- Mioko Matsuo
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.H.); (R.K.); (M.S.); (S.M.); (T.N.)
| | - Muneyuki Masuda
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka 811-1395, Japan;
| | - Moriyasu Yamauchi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan;
| | - Kazuki Hashimoto
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.H.); (R.K.); (M.S.); (S.M.); (T.N.)
| | - Ryunosuke Kogo
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.H.); (R.K.); (M.S.); (S.M.); (T.N.)
| | - Masanobu Sato
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.H.); (R.K.); (M.S.); (S.M.); (T.N.)
| | - Shogo Masuda
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.H.); (R.K.); (M.S.); (S.M.); (T.N.)
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (K.H.); (R.K.); (M.S.); (S.M.); (T.N.)
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Hiraizumi K, Honda C, Watanabe A, Nakao T, Midorikawa S, Abe H, Matsui N, Yamamoto T, Sakamoto T. Safety of nivolumab monotherapy in five cancer types: pooled analysis of post-marketing surveillance in Japan. Int J Clin Oncol 2024; 29:932-943. [PMID: 38844668 PMCID: PMC11196337 DOI: 10.1007/s10147-024-02515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/13/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Nivolumab has been approved for treating ≥ 10 cancer types. However, there is limited information on the incidence of rare, but potentially serious, treatment-related adverse events (TRAEs), as well as notable TRAEs in patients with certain medical disorders or older patients in Japan. METHODS We performed pooled analyses of data from published post-marketing surveillance in Japan of nivolumab monotherapy for patients with malignant melanoma, non-small cell lung cancer, renal cell carcinoma, head and neck cancer, and gastric cancer to determine the frequencies of 20 categories of TRAEs of special interest overall and in patient groups with higher perceived safety risks (history of autoimmune disease, interstitial lung disease, tuberculosis, or hepatitis B/C; patients vaccinated during nivolumab treatment; and older patients [≥ 75 years]). RESULTS The overall population comprised 7421 patients treated with nivolumab. TRAEs were reported in 49.1% of patients, with grade ≥ 3 TRAEs in 16.7%. Endocrine disorders (14.4%), hepatobiliary disorders (10.9%), and interstitial lung disease (7.0%) were the three most common categories (any grade). The incidences of rare TRAEs with high risk of becoming serious, which occurred in < 1% of patients, were consistent with those in previous reports. The frequencies of TRAEs were not markedly increased in the specified patient groups relative to the overall population. CONCLUSION To our knowledge, this is the largest study examining the safety of nivolumab-treated patients in real-world clinical practice including rare but potentially serious TRAEs. We found no new signals in the safety of nivolumab among the patient groups relative to the overall population, and no additional safety measures are required in these groups. Trial registration UMIN000048892 (overall analysis), JapicCTI-163272 (melanoma), Japic-163271 (non-small cell lung cancer), JapicCTI-184071 (head and neck cancer), JapicCTI-184070 (gastric cancer), and JapicCTI-184069 (renal cell cancer).
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Affiliation(s)
- Kenji Hiraizumi
- Oncology Medical Affairs, Ono Pharmaceutical Co., Ltd., 1-8-2 Kyutaromachi, Chuo-ku, Osaka, 541-8564, Japan
| | - Chikara Honda
- PV Data Strategy, Pharmacovigilance Department, Ono Pharmaceutical Co., Ltd., 2-1-5 Dosho-machi, Chuo-ku, Osaka, 541-8526, Japan
| | - Ayu Watanabe
- Safety Management Pharmacovigilance Department, Ono Pharmaceutical Co., Ltd., 2-1-5 Dosho-machi, Chuo-ku, Osaka, 541-8526, Japan
| | - Takafumi Nakao
- Safety Management Pharmacovigilance Department, Ono Pharmaceutical Co., Ltd., 2-1-5 Dosho-machi, Chuo-ku, Osaka, 541-8526, Japan
| | - Shuichi Midorikawa
- Biometrics and Data Sciences, R&D Department, Bristol-Myers Squibb K.K., Otemachi One Tower, 1-2-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Hiromi Abe
- Oncology Medical, Bristol-Myers Squibb K.K., Otemachi One Tower, 1-2-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Nobuki Matsui
- Patient Safety Japan, Bristol-Myers Squibb K.K., Otemachi One Tower, 1-2-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Tsunehisa Yamamoto
- Oncology Medical, Bristol-Myers Squibb K.K., Otemachi One Tower, 1-2-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Takahiko Sakamoto
- Safety Management Pharmacovigilance Department, Ono Pharmaceutical Co., Ltd., 2-1-5 Dosho-machi, Chuo-ku, Osaka, 541-8526, Japan.
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Kawasaki A, Hatake K, Matsumura I, Izutsu K, Hoshino T, Akamatsu A, Kakuuchi A, Tobinai K. Post-marketing surveillance of the safety and effectiveness of nivolumab for classic Hodgkin lymphoma in Japan. Int J Hematol 2024; 119:667-676. [PMID: 38521840 PMCID: PMC11136857 DOI: 10.1007/s12185-024-03734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
Nivolumab was approved for relapsed/refractory classic Hodgkin lymphoma (cHL) in Japan in 2016. After its approval, a prospective, non-interventional, observational post-marketing surveillance was initiated to evaluate the safety and effectiveness of nivolumab treatment for up to 12 months in patients with relapsed/refractory cHL. Of 304 registered patients, 288 were included in safety analyses and 282 in effectiveness analyses. There were 191 (66.3%) male patients, median age was 64.0 years, and 54 patients (18.8%) had performance status ≥ 2. Treatment-related adverse events (TRAEs) were reported in 183 (63.5%) patients, with grade 3-5 TRAEs in 86 (29.9%). The most common TRAEs were infusion reaction (14.6%), hepatic function abnormal (5.9%), interstitial lung disease (ILD) (5.6%), and hypothyroidism (5.2%). TRAEs of special interest in ≥ 5% of patients were infusion reaction (15.6%), hepatic failure/hepatic dysfunction/hepatitis/cholangitis sclerosing (13.2%), thyroid dysfunction (9.7%), and ILD (7.3%). In multivariable analyses, prior allogeneic hematopoietic stem cell transplantation was a risk factor for hepatic failure/hepatic dysfunction/hepatitis/cholangitis sclerosing, and prior thyroid gland disorders was a risk factor for thyroid dysfunction. The overall response rate was 61.7%. In conclusion, nivolumab showed a similar safety profile and comparable effectiveness to that reported in clinical trials for relapsed/refractory cHL (CheckMate 205, ONO-4538-15).
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Affiliation(s)
- Akira Kawasaki
- Ono Pharmaceutical Co., Ltd, 1-5, Dosho-machi 2-chome, Chuo-ku, Osaka, 541-8526, Japan.
| | - Kiyohiko Hatake
- Department of Hematology, International University of Health and Welfare, Tokyo, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Hoshino
- Ono Pharmaceutical Co., Ltd, 1-5, Dosho-machi 2-chome, Chuo-ku, Osaka, 541-8526, Japan
| | - Ayumi Akamatsu
- Ono Pharmaceutical Co., Ltd, 1-5, Dosho-machi 2-chome, Chuo-ku, Osaka, 541-8526, Japan
| | - Akito Kakuuchi
- Ono Pharmaceutical Co., Ltd, 1-5, Dosho-machi 2-chome, Chuo-ku, Osaka, 541-8526, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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Iwasa YI, Kitoh R, Yokota Y, Hori K, Kasuga M, Kobayashi T, Kanda S, Takumi Y. Post-treatment Neutrophil/Lymphocyte Ratio Is a Prognostic Factor in Head and Neck Cancers Treated With Nivolumab. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:182-188. [PMID: 38434918 PMCID: PMC10905290 DOI: 10.21873/cdp.10305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/05/2024] [Indexed: 03/05/2024]
Abstract
Background/Aim Inflammation and nutrition-based biomarkers, such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), have prognostic value for several types of malignancies. Markers that precisely reflect the prognosis of patients with head and neck cancers (HNCs) treated with immune-checkpoint inhibitors remain unclear. This retrospective study aimed to investigate the prognostic value of hematological markers before and after treatment with nivolumab in patients with recurrent or metastatic HNC (RM-HNC). Patients and Methods We evaluated the clinical data of 44 patients with recurrent/metastatic head and neck squamous cell carcinoma treated with nivolumab between April 2017 and April 2023 at Shinshu University Hospital. Values of hematological biomarkers (NLR, LMR, PLR, CAR, PNI, SII, and SIRI) were calculated before and 4-6 weeks after nivolumab initiation. Receiver operating characteristic curves were constructed to determine the cutoff values of pre- and post-treatment markers for overall survival (OS) and progression-free survival (PFS). Results Among all pre- and post-treatment markers, post-treatment NLR showed the highest area under the curve (AUC=0.702). A high post-treatment NLR (cutoff value, 4.01) was associated with a poor OS (p=0.027) and a tendency for shorter PFS (p=0.117). Multivariate analysis showed that a high post-treatment NLR was significantly associated with poor OS (p=0.026). Conclusion A high post-treatment NLR was associated with poor response to nivolumab in head and neck cancers.
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Affiliation(s)
- Yoh-Ichiro Iwasa
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryosuke Kitoh
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoh Yokota
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Hori
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mariko Kasuga
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Kobayashi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shintaro Kanda
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yutaka Takumi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Spagnolo P, Chaudhuri N, Bernardinello N, Karampitsakos T, Sampsonas F, Tzouvelekis A. Pulmonary adverse events following immune checkpoint inhibitors. Curr Opin Pulm Med 2022; 28:391-398. [PMID: 35838354 PMCID: PMC10810354 DOI: 10.1097/mcp.0000000000000895] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitors (ICIs) have rapidly become a mainstay of cancer treatment. However, immune modulation resulting from checkpoint inhibition can cause inflammation in any organ system, with pneumonitis being one of the most severe immune-related adverse events (irAEs). Here, we review the most recent literature on pulmonary adverse events following ICIs. RECENT FINDINGS Several systematic reviews and meta-analyses of data from trials of antiprogrammed death-1 (PD-1; nivolumab, pembrolizumab), anti-PD-ligand-1 (PD-L1; atezolizumab, avelumab, durvalumab) and anticytotoxic T lymphocyte antigen-4 (CTLA-4; ipilimumab or tremelimumab) in patients with advanced cancer have explored the relative risk and incidence of lung toxicity among different tumor types and therapeutic regimens. They have showed that the incidence of all-grade (1-4) and high-grade (3-4) pneumonitis is significantly higher in nonsmall cell lung cancer (NSCLC) compared with other tumor types. In addition, they have demonstrated that immunotherapy, especially monoimmunotherapy, has a significantly lower risk of irAEs compared to immune-chemotherapy. Treatment for lung cancer, preexisting interstitial lung disease, smoking history and male sex appear to increase the risk for ICI-related pneumonitis. SUMMARY Lung toxicity is an uncommon but potentially severe and even fatal complication of ICIs. Timely recognition is critically important but challenging, particularly in patients with lung cancer wherein drug toxicity can mimic disease progression or recurrence.
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Affiliation(s)
- Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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Uhara H, Tsuchida T, Kiyohara Y, Akamatsu A, Sakamoto T, Yamazaki N. Safety and effectiveness of nivolumab in Japanese patients with malignant melanoma: Final analysis of a post-marketing surveillance. J Dermatol 2022; 49:862-871. [PMID: 35607248 PMCID: PMC9545090 DOI: 10.1111/1346-8138.16432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
Nivolumab, a monoclonal antibody against human programmed death 1, was approved for the treatment of melanoma in July 2014 in Japan. Because the Japanese phase II studies (ONO-4538-02, ONO-4538-08) enrolled small numbers of melanoma patients, post-marketing surveillance (PMS; JapicCTI-163 272) was conducted to collect safety data in a larger patient population. We report data for melanoma patients who received nivolumab between July 4, 2014 and February 28, 2017. Data collected included baseline characteristics, laboratory tests, treatment-related adverse events (TRAE), and overall survival (OS). Of 2069 enrolled patients, 2008 patients were included in the safety analysis population. There were 1030 (51.3%) males, the median age was 69 years, and 269 patients (13.4%) had a performance status of ≥2. The primary tumor sites were cutaneous (34.4%), mucosal (34.2%), acral lentiginous (18.6%), others (6.8%), and unknown (6.3%). TRAE occurred in 62.1% of patients, the most common being hypothyroidism (14.0%), increased aspartate aminotransferase (8.5%), and increased alanine aminotransferase (6.9%). TRAE of special interest in ≥5% of patients were thyroid dysfunction (24.9%), hepatic dysfunction (20.6%), infusion reactions (11.4%), colitis/severe diarrhea (6.3%), and interstitial lung disease (ILD; 5.0%). Several types of TRAE of special interest, which included myasthenia gravis/myocarditis/myositis/rhabdomyolysis (0.9%), venous thromboembolism (0.2%), immune thrombocytopenic purpura (0.1%), and encephalitis (0.0%), were observed in this PMS. Although these TRAE were not reported in previous studies (ONO-4538-02, ONO-4538-08, CheckMate 066, and CheckMate 037), they have been listed in the current Risk Management Plan. History of ILD and male sex were risk factors for ILD in a multivariable analysis. Age <75 years was a risk factor for hepatic dysfunction. At 12 months, median OS was not reached. In conclusion, these results suggested that there was no concern requiring additional precautions for the safety of nivolumab in Japanese patients with melanoma other than the safety information in the Risk Management Plan.
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Affiliation(s)
- Hisashi Uhara
- Department of DermatologySapporo Medical University School of MedicineSapporoJapan
| | | | - Yoshio Kiyohara
- Dermatology DivisionShizuoka Cancer Center HospitalShizuokaJapan
| | | | | | - Naoya Yamazaki
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
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