Real-world experience with pembrolizumab toxicities in advanced melanoma patients: a single-center experience in the UK.

AIM: We aimed to characterize the safety profile of pembrolizumab in advanced melanoma patients at our center to better reflect 'real-world' data on anti-PD-1 inhibitors. MATERIALS & METHODS: At our institution, 58 ipilimumab-naive and 30 ipilimumab-treated patients with advanced melanoma who have received pembrolizumab between June 2014 and June 2017 were included for analysis. RESULTS: Incidence of any-grade and grade 3/4 toxicities were 81.8% (n = 72) and 12.5% (n = 11), respectively. The most common side effects were skin-related (61.4%, n = 54) and gastrointestinal-related (51.1%, n = 45) events. In total, 25% of patients required oral steroids to manage immune-related adverse events with a median cumulative prednisolone dose of 683 mg (range: 40-3745 mg). CONCLUSION: Pembrolizumab is well tolerated in 'real-world' patients and severe toxicities can be effectively managed with systemic steroids.

Managing side effects of cancer immunotherapy for the acute physician.

Immunotherapy is a novel type of anti-cancer treatment that works by upregulating the host's immune system to fight against cancer cells. Landmark immunotherapy trials have demonstrated improvements in response rates and survival compared to cytotoxic chemotherapy. Specific immunotherapies known as checkpoint inhibitors are now routinely used in a range of cancers including melanoma, lung, renal and urological cancers. Immunotherapies are associated with immune-related adverse events which are very different to those seen with traditional cytotoxic chemotherapies. This can present a new challenge to oncologists, acute physicians and the wider team of health-care professionals who look after patients receiving immunotherapy. Generally, these side effects are easily managed but some, if untreated, can be subtle and potentially life-threatening. Patients on immunotherapy may present to a wide variety of medical professionals including the emergency department, primary care and general medical admissions units. It is therefore vital that there is increased awareness and education to identify and manage side effects of immunotherapy effectively.