The utilisation of immunotherapy in Australia has expanded far beyond the use of interferons and IL-2 for melanoma and renal cell carcinomas. The success of CTLA-4 and PD-1 immune checkpoint inhibitors in metastatic melanoma has led to their adoption in other malignancies prior to PBS listing. In August 2017, these agents were approved by the PBS for both non-small cell lung cancer and renal cancer patients. Traditionally these agents were administered through clinical trials in metropolitan sites with multi-disciplinary support. The number of regional and rural patients treated with these agents has increased as oncologists become more comfortable with their adverse event profile.
Although immunotherapy generally has a favourable toxicity profile compared to chemotherapy, they can provoke mild to life-threatening immune-related adverse effects (irAEs) caused by an unregulated and hyperstimulated immune response. Our aim was to compare the utilisation of these immunotherapy agents and the rates, management and outcomes of irAEs between a regional and tertiary oncology service.
We reviewed the medical records for all patients treated with immunotherapy in the participating services for the five year period from 31st July 2012 to 31st July 2017. There were 86 patients treated in the tertiary service and 96 patients in the regional service. To date, data has been extracted for 46 and 37 patients at the tertiary and regional services respectively. The rate of irAEs were 23.9% and 27% between the tertiary and regional centres; 8.7% and 13% had grade 3/4 irAEs. There were 3 patients admitted to hospital for irAEs in both centres taking a total of 35 (tertiary) and 12 (regional) bed days. There are no statistically significant differences.
Data will be finalised and presented at the meeting, including comparisons of the management strategies, costs and outcomes and overall patient outcomes between the tertiary and regional centres.