Impact of immune checkpoint inhibitors on unplanned emergency department consultations in mNSCLC: More toxicities or lack of knowledge of their management.

Abstract

e24099 Background: Immune checkpoint inhibitors (ICIs) have revolutionized the landscape of metastatic non-small cell Lung cancer (mNSCLC) treatment, alone or in association with chemotherapy, with a specific profile of toxicities that may sometimes require particular medical attention. Methods: We conducted a retrospective study to analyze the impact of these novel agents on unplanned emergency department consultations (ED-Cs) compared to chemotherapy, for patients with metastatic lung adenocarcinoma. We collected data for all patients treated at Gustave Roussy between January 2016 and December 2022. All unscheduled ED-Cs during the first-line metastatic treatment phase were assessed. Results: One hundred and ninty eight patients were included, primarily men (58,1%) and smokers (90%). Forty-seven per cent of patients received chemotherapy (CT) associated with ICI, 26% CT alone and 27% ICI alone. Up to 44% of patients had at least 1 ED-Cs during first-line treatment, especially in the ICI group (54% versus 31% in the CT group and 46% in CT+ICI group), mainly during the first 3 months of treatment (59%). Of note, 20% of patients had at least 1 ED-C in the ICI occurring more than 6 months after treatment initiation, versus 4% in the CT alone group and 13% in the CT+ICT group (p = 0.0399). The main complaint was dyspnea (32,6%), followed by fever (22,7%), gastrointestinal symptoms (18,2%) and pain (15.9%). Most patients were hospitalized (78%) with a median duration of seven days, independent of the treatment regimen. One-third of all ED-Cs were related to treatment adverse events, of which 45,5% attributed to ICIs, 38,6% to CT, and 15,9% to the combination. Conclusions: This study demonstrated more unplanned ED-Cs with ICI monotherapy than chemotherapy or the combination, with more delayed events in this group. Notably, these consultations often resulted in prolonged and heavy hospitalizations, contrasting with the expectation of lower toxicity associated with ICIs. The long duration of response to ICI and the lack of accustomed management of ICI side effects during this period could explain these results.