Survivorship in immune therapy

Assessing chronic immune toxicities, health outcomes, and functional status among long-term ipilimumab survivors at a single referral center

Douglas B. Johnson, Debra L. Friedman, Elizabeth Berry, Ilka Decker, Fei Ye, Shilin Zhao, Alicia K. Morgans, Igor Puzanov, Jeffrey A. Sosman, Christine M. Lovly

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Ipilimumab, a novel immune checkpoint inhibitor, is associated with long-term survival in approximately 20% of patients with advanced melanoma and is also being evaluated in the adjuvant setting. With this growing cohort of survivors, long-term health outcomes, chronic toxicities, and functional outcomes among survivors treated with ipilimumab need to be defined. Using retrospective medical record abstraction, we evaluated disease status, chronic immune- and non-immune-related health events, pharmacologic management of symptoms, and functional status in patients with melanoma, with overall survival >2 years following ipilimumab treatment at Vanderbilt University. Ninety patients received ipilimumab for metastatic disease or as adjuvant therapy between January 2006 and September 2012, and 33 patients survived >2 years, with a median overall survival of 60.1 months. Of these, 24 patients were alive at the last follow-up (73%), with 14 patients free of disease (42%). Gastrointestinal and dermatologic adverse events were frequent but largely transient. By contrast, patients with hypophysitis universally required ongoing corticosteroids, although largely remained asymptomatic with appropriate hormone replacement. Surviving patients generally had excellent performance status (ECOG 0-1 in 23 of 24). Chronic neurologic toxicities caused substantial morbidity and mortality in 2 patients who received whole-brain radiotherapy >5 years before analysis, and in one patient with chronic, painful peripheral neuropathy. No previously undescribed cardiac, pulmonary, gastrointestinal, hematologic, or neoplastic safety signals were identified. In conclusion, ipilimumab was associated with largely excellent functional outcomes among long-term survivors. Chronic endocrine dysfunction and occasional neurologic toxicity (primarily associated with whole-brain radiation) were observed in a small number of patients.

Original languageEnglish (US)
Pages (from-to)464-469
Number of pages6
JournalCancer Immunology Research
Volume3
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

Fingerprint

Survivors
Referral and Consultation
Survival Rate
Health
Therapeutics
Survival
Melanoma
ipilimumab
Brain
Peripheral Nervous System Diseases
Neurologic Manifestations
Nervous System
Medical Records
Adrenal Cortex Hormones
Chronic Disease
Radiotherapy
Hormones
Radiation
Morbidity
Safety

ASJC Scopus subject areas

  • Immunology
  • Cancer Research

Cite this

Survivorship in immune therapy : Assessing chronic immune toxicities, health outcomes, and functional status among long-term ipilimumab survivors at a single referral center. / Johnson, Douglas B.; Friedman, Debra L.; Berry, Elizabeth; Decker, Ilka; Ye, Fei; Zhao, Shilin; Morgans, Alicia K.; Puzanov, Igor; Sosman, Jeffrey A.; Lovly, Christine M.

In: Cancer Immunology Research, Vol. 3, No. 5, 01.05.2015, p. 464-469.

Research output: Contribution to journalArticle

Johnson, Douglas B. ; Friedman, Debra L. ; Berry, Elizabeth ; Decker, Ilka ; Ye, Fei ; Zhao, Shilin ; Morgans, Alicia K. ; Puzanov, Igor ; Sosman, Jeffrey A. ; Lovly, Christine M. / Survivorship in immune therapy : Assessing chronic immune toxicities, health outcomes, and functional status among long-term ipilimumab survivors at a single referral center. In: Cancer Immunology Research. 2015 ; Vol. 3, No. 5. pp. 464-469.
@article{6f9db207520a4c5fa62ca6da9d0a407e,
title = "Survivorship in immune therapy: Assessing chronic immune toxicities, health outcomes, and functional status among long-term ipilimumab survivors at a single referral center",
abstract = "Ipilimumab, a novel immune checkpoint inhibitor, is associated with long-term survival in approximately 20{\%} of patients with advanced melanoma and is also being evaluated in the adjuvant setting. With this growing cohort of survivors, long-term health outcomes, chronic toxicities, and functional outcomes among survivors treated with ipilimumab need to be defined. Using retrospective medical record abstraction, we evaluated disease status, chronic immune- and non-immune-related health events, pharmacologic management of symptoms, and functional status in patients with melanoma, with overall survival >2 years following ipilimumab treatment at Vanderbilt University. Ninety patients received ipilimumab for metastatic disease or as adjuvant therapy between January 2006 and September 2012, and 33 patients survived >2 years, with a median overall survival of 60.1 months. Of these, 24 patients were alive at the last follow-up (73{\%}), with 14 patients free of disease (42{\%}). Gastrointestinal and dermatologic adverse events were frequent but largely transient. By contrast, patients with hypophysitis universally required ongoing corticosteroids, although largely remained asymptomatic with appropriate hormone replacement. Surviving patients generally had excellent performance status (ECOG 0-1 in 23 of 24). Chronic neurologic toxicities caused substantial morbidity and mortality in 2 patients who received whole-brain radiotherapy >5 years before analysis, and in one patient with chronic, painful peripheral neuropathy. No previously undescribed cardiac, pulmonary, gastrointestinal, hematologic, or neoplastic safety signals were identified. In conclusion, ipilimumab was associated with largely excellent functional outcomes among long-term survivors. Chronic endocrine dysfunction and occasional neurologic toxicity (primarily associated with whole-brain radiation) were observed in a small number of patients.",
author = "Johnson, {Douglas B.} and Friedman, {Debra L.} and Elizabeth Berry and Ilka Decker and Fei Ye and Shilin Zhao and Morgans, {Alicia K.} and Igor Puzanov and Sosman, {Jeffrey A.} and Lovly, {Christine M.}",
year = "2015",
month = "5",
day = "1",
doi = "10.1158/2326-6066.CIR-14-0217",
language = "English (US)",
volume = "3",
pages = "464--469",
journal = "Cancer immunology research",
issn = "2326-6066",
publisher = "American Association for Cancer Research Inc.",
number = "5",

}

TY - JOUR

T1 - Survivorship in immune therapy

T2 - Assessing chronic immune toxicities, health outcomes, and functional status among long-term ipilimumab survivors at a single referral center

AU - Johnson, Douglas B.

AU - Friedman, Debra L.

AU - Berry, Elizabeth

AU - Decker, Ilka

AU - Ye, Fei

AU - Zhao, Shilin

AU - Morgans, Alicia K.

AU - Puzanov, Igor

AU - Sosman, Jeffrey A.

AU - Lovly, Christine M.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Ipilimumab, a novel immune checkpoint inhibitor, is associated with long-term survival in approximately 20% of patients with advanced melanoma and is also being evaluated in the adjuvant setting. With this growing cohort of survivors, long-term health outcomes, chronic toxicities, and functional outcomes among survivors treated with ipilimumab need to be defined. Using retrospective medical record abstraction, we evaluated disease status, chronic immune- and non-immune-related health events, pharmacologic management of symptoms, and functional status in patients with melanoma, with overall survival >2 years following ipilimumab treatment at Vanderbilt University. Ninety patients received ipilimumab for metastatic disease or as adjuvant therapy between January 2006 and September 2012, and 33 patients survived >2 years, with a median overall survival of 60.1 months. Of these, 24 patients were alive at the last follow-up (73%), with 14 patients free of disease (42%). Gastrointestinal and dermatologic adverse events were frequent but largely transient. By contrast, patients with hypophysitis universally required ongoing corticosteroids, although largely remained asymptomatic with appropriate hormone replacement. Surviving patients generally had excellent performance status (ECOG 0-1 in 23 of 24). Chronic neurologic toxicities caused substantial morbidity and mortality in 2 patients who received whole-brain radiotherapy >5 years before analysis, and in one patient with chronic, painful peripheral neuropathy. No previously undescribed cardiac, pulmonary, gastrointestinal, hematologic, or neoplastic safety signals were identified. In conclusion, ipilimumab was associated with largely excellent functional outcomes among long-term survivors. Chronic endocrine dysfunction and occasional neurologic toxicity (primarily associated with whole-brain radiation) were observed in a small number of patients.

AB - Ipilimumab, a novel immune checkpoint inhibitor, is associated with long-term survival in approximately 20% of patients with advanced melanoma and is also being evaluated in the adjuvant setting. With this growing cohort of survivors, long-term health outcomes, chronic toxicities, and functional outcomes among survivors treated with ipilimumab need to be defined. Using retrospective medical record abstraction, we evaluated disease status, chronic immune- and non-immune-related health events, pharmacologic management of symptoms, and functional status in patients with melanoma, with overall survival >2 years following ipilimumab treatment at Vanderbilt University. Ninety patients received ipilimumab for metastatic disease or as adjuvant therapy between January 2006 and September 2012, and 33 patients survived >2 years, with a median overall survival of 60.1 months. Of these, 24 patients were alive at the last follow-up (73%), with 14 patients free of disease (42%). Gastrointestinal and dermatologic adverse events were frequent but largely transient. By contrast, patients with hypophysitis universally required ongoing corticosteroids, although largely remained asymptomatic with appropriate hormone replacement. Surviving patients generally had excellent performance status (ECOG 0-1 in 23 of 24). Chronic neurologic toxicities caused substantial morbidity and mortality in 2 patients who received whole-brain radiotherapy >5 years before analysis, and in one patient with chronic, painful peripheral neuropathy. No previously undescribed cardiac, pulmonary, gastrointestinal, hematologic, or neoplastic safety signals were identified. In conclusion, ipilimumab was associated with largely excellent functional outcomes among long-term survivors. Chronic endocrine dysfunction and occasional neurologic toxicity (primarily associated with whole-brain radiation) were observed in a small number of patients.

UR - http://www.scopus.com/inward/record.url?scp=84962286789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962286789&partnerID=8YFLogxK

U2 - 10.1158/2326-6066.CIR-14-0217

DO - 10.1158/2326-6066.CIR-14-0217

M3 - Article

VL - 3

SP - 464

EP - 469

JO - Cancer immunology research

JF - Cancer immunology research

SN - 2326-6066

IS - 5

ER -