Safety and efficacy of anti-PD-1 in patients with baseline cardiac, renal, or hepatic dysfunction
Open accessAbstract
BACKGROUND: Anti-PD-1 therapy is increasingly used in various advanced malignancies. Patients with baseline organ dysfunction are largely excluded from clinical trials. Therefore it is unclear whether anti-PD-1 therapy is safe or effective in this setting. Further, these patients are often not candidates for other anti-cancer therapies, highlighting their need for active treatment options. METHODS: We performed a retrospective analysis of patients from multiple centers with advanced solid tumors and baseline organ dysfunction who received anti-PD-1 therapy. Organ dysfunction was defined as cardiac (left ventricular ejection fraction ≤45 %), renal (creatinine ≥2 mg/dL or GFR ≤30 ml/min) or hepatic dysfunction (evidence of cirrhosis on imaging or AST, ALT or bilirubin ≥3x ULN). We assessed change in organ dysfunction, immune related adverse events (irAEs), response rate, progression free survival (PFS) and overall survival (OS). RESULTS: = 17), hepatic dysfunction (7), cardiac dysfunction (11), including >1 organ dysfunction (8). Worsening organ dysfunction requiring hospitalization or dose delays occurred in 8 patients (30 %) although in most cases this was thought not-drug related and resolved with supportive care. Grade 3 irAEs occurred in 2 pts (7 %; hepatitis and colitis). Thirteen of 27 patients had ongoing treatment benefit (objective response or stable disease) at data collection (48 %). Eleven patients had primary progressive disease (41 %), 11 had stable disease (41 %), 4 had partial responses (15 %), and one had a complete response (4 %). Overall, median PFS was 168 days. Median OS was not reached. CONCLUSIONS: In our experience, anti-PD-1 agents in this group of patients with cardiac, hepatic or renal dysfunction were associated with tolerable irAEs and infrequent manageable worsening of organ dysfunction. Further, objective responses and prolonged PFS were observed in a number of patients. Thus, patients with baseline organ dysfunction may be considered for anti-PD-1 therapy with appropriate clinical monitoring.
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Several studies suggest thyroid dysfunction is associated with improved overall cancer survival, though the mechanism is not well understood.
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- Authors
- Kanz, B. A., Pollack, M. H., Johnpulle, R., Puzanov, I., Horn, L., Morgans, A., Sosman, J. A., Rapisuwon, S., Conry, R. M., Eroglu, Z., & Johnson, D. B.
- Affiliations
- Vanderbilt-Ingram Cancer Center (US)
- Vanderbilt University (US)
- Roswell Park Comprehensive Cancer Center (US)
- Georgetown Lombardi Comprehensive Cancer Center (US)
- University of Alabama at Birmingham (US)
- Moffitt Cancer Center (US)
- Corresponding author
- Johnson, Douglas B.
- ORCID
- Venue
- Journal for ImmunoTherapy of Cancer
- Publisher
- BMJ
- Published
- 2016-10-18
- Volume
- 4
- Issue
- 1
- Pages
- 60-60
- ISSN
- 2051-1426 (ISSN-L)
- PMC
- PMC5067899
- OpenAlex
- W2522875140
- Cited by
- 75
- References
- 20
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 17 · 2019: 10 · 2018: 8 · 2017: 7
- FWCI
- 4.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal for ImmunoTherapy of Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Cancer Institute (K23CA204726, K12CA090625)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
- Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
- Keywords
- anti-PD-1 therapy, immune checkpoint inhibitors, cardiac dysfunction, renal dysfunction, liver dysfunction, immune-related adverse events, advanced solid tumors, treatment safety, treatment efficacy, progression-free survival, overall survival
- MeSH terms
- Positron Emission Tomography Computed Tomography, Antineoplastic Agents, Immunological, Aged, Aged, 80 and over, Female, Heart, Heart Function Tests, Humans, Kidney, Kidney Function Tests, Liver, Liver Function Tests, Male, Middle Aged, Neoplasm Staging, Neoplasms, Retrospective Studies, Treatment Outcome, Molecular Targeted Therapy, Programmed Cell Death 1 Receptor, Cardiotoxicity
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