Oncology has been revolutionised by the expanding indications for checkpoint inhibitors (CPI). It is critical that patients from non-metropolitan centres have access to these drugs to minimise healthcare inequality. We aimed to assess the safety and viability of immunotherapy delivery at a regional centre in Queensland.
A retrospective analysis was performed for all patients with advanced solid tumour malignancies receiving a CPI between 2013 to 2017. Patient details including primary malignancy, CPI used, duration of treatment and reason for cessation were captured. The incidence, type, grade and management of immune-related adverse events (IRAEs) were compared to published data.
Of 74 patients, the median age at commencement was 64.5years (range 38-81). Non-small cell lung cancer (45%) and melanoma (45%) were the most common primary tumours. Median number of treatment cycles (excluding ipilimumab) was 5 (range 1-68) at data cutoff. Twenty-one patients (29%) had at least one IRAE. Of the total 33 IRAEs, rash/dermatitis was the most common (27%), followed by thyroid dysfunction (15%) and colitis (15%). Most documented IRAEs were grade 2 (48.5%); grade 1 (36.5%) and grade 3 (15%); there were no grade 4 or 5 events. Management of IRAEs was consistent with manufacturer and published guidelines. Corticosteroids were employed in all grade 2/3 IRAEs and subspecialist consultation was sought in all grade 3 IRAE. The most common reason for discontinuation of treatment was terminal decline (38%), or progressive disease (25%).
At our regional centre in Queensland, the use of CPI for advanced solid tumour malignancies has rapidly increased. Our review suggests that CPI can be safely administered at a regional centre, with the incidence of IRAEs similar to published phase III data and management consistent with established guidelines. Future studies should consider comparing the outcomes between metropolitan and regional centres for CPI therapy.