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Absence of significant clinical benefit for a systematic routine creatine phosphokinase measurement in asymptomatic patients treated with anti-programmed death protein (ligand) 1 immune checkpoint inhibitor to screen cardiac or neuromuscular immune-related toxicities
- Source :
- European journal of cancer (Oxford, England : 1990). 157
- Publication Year :
- 2021
-
Abstract
- Aim Despite unprecedented results of anti-programmed death protein (ligand) 1 (PD-(L)1) immune checkpoint inhibitor in the oncology's armamentarium, immune-related adverse events (irAEs) represent a therapeutic hurdle. Currently, there is no consensual recommendation on a routinely monitored biomarker to early detect irAE. Biological markers such as serum creatine phosphokinase (CPK) are commonly used to measure muscular tissue injury. The potential of routine serum CPK monitoring to predict cardiac or neuromuscular irAE in patients treated with immunotherapy remains unknown. Methods In this retrospective study between January 2016 and December 2018 at Gustave Roussy Cancer Campus, 1151 cancer patients treated with anti-PD–(L)1 immunotherapy were systematically monitored with serum CPK measurements before each immunotherapy cycle. We considered significant CPK increases according to Common Terminology Criteria for Adverse Events v5.0 (CTCAEV5) of grade ≥2 severity. Comparisons were performed in patients with immune-related CPK (ir-CPK) elevations symptomatic versus asymptomatic. Results Overall, 53 of 1151 (4.6%) patients showed a CPK increase. Elevations of CPK were deemed to be immunotherapy-related in 31 of 1151 (2.7%) patients. Among them, 12 of 31 (38.7%) patients experienced symptomatic cardiac or neuromuscular irAE, whereas the other 19 of 31 (61.3%) patients remained asymptomatic. In patients with symptomatic irAE, the mean ir-CPK level was higher compared with asymptomatic patients (1271 versus 771 UI/L, P value = 0.02). In the asymptomatic group, all patients experienced a spontaneous resolution of the ir-CPK increase, and none required medical intervention. Conclusion Most patients with immune-related CPK increase remained asymptomatic. The CPK serum increase did not alter the clinical management of asymptomatic patients. The results of this study did not support a significant clinical interest for a systematic routine CPK monitoring in patients amenable to anti-PD-(L)1 immunotherapy.
- Subjects :
- Male
Cancer Research
medicine.medical_specialty
medicine.medical_treatment
Memory, Episodic
Programmed Cell Death 1 Receptor
Gastroenterology
Asymptomatic
B7-H1 Antigen
Immune system
Internal medicine
Neoplasms
medicine
Humans
Adverse effect
Creatine Kinase
Immune Checkpoint Inhibitors
Retrospective Studies
business.industry
fungi
Cancer
Retrospective cohort study
Common Terminology Criteria for Adverse Events
Immunotherapy
Neuromuscular Diseases
Middle Aged
medicine.disease
Cardiotoxicity
Oncology
Biomarker (medicine)
Feasibility Studies
Female
medicine.symptom
business
Biomarkers
Subjects
Details
- ISSN :
- 18790852
- Volume :
- 157
- Database :
- OpenAIRE
- Journal :
- European journal of cancer (Oxford, England : 1990)
- Accession number :
- edsair.doi.dedup.....cf1483b4b99b2d5a1d5425c49704be64