2226. Immune Checkpoint Inhibitors in Solid Tumor Patients with Chronic Hepatitis C Virus Infection: A prospective case-series
Session: Poster Abstract Session: Hepatitis A, B, and C
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Immune checkpoint inhibitors in solid tumor patients-IDweek 2018-Final.pdf (675.0 kB)
  • Background: Immune checkpoint inhibitors are a novel class of targeted therapy that activate T cell-mediated tumor cell death. Controversies exist about the safety and efficacy of immunotherapy in patients with chronic viral infections affecting T cells, such as hepatitis C virus (HCV). Herein, we analyzed the effect of immune checkpoint inhibitors on HCV viremia and HCV-related hepatic outcome.

    Methods: HCV-infected patients with solid tumors seen at MD Anderson Cancer Center (11/2012 - 4/2018) were enrolled in a prospective observational study. Patients were monitored for the development of HCV reactivation (HCV-RNA ≥1 log10IU/mL over baseline), hepatitis flare (alanine transaminase increase to ≥3 times upper limit of normal) and HCV-associated hepatitis (HCV reactivation and hepatitis flare) while on cancer treatment.

    Results: Out of 205 chronically infected patients with solid tumors, 12 (6%) received immunotherapy and were seen in the HCV clinic, but only 4 (2%) returned for regular monitoring (Table 1). They were followed for 9 months. None of the 4 patients received concomitant chemotherapy or steroids. Hepatitis flare occurred in 3 patients, but HCV reactivation or HCV-associated hepatitis were not detected in any study patient. Immune checkpoint inhibitors were discontinued in one patient (25%) due to hepatitis flare unrelated to HCV.

    Conclusion: The use of immune checkpoint inhibitors appears to be safe in solid tumor patients with HCV infection.

    Table 1. Demographics, types of cancer, immunotherapy received, and changes in serum HCV-RNA

    Patient

    Age, y

    Sex

    HCV genotype

    Cirrhosis

    Type of Cancer

    Immunotherapy

    Baseline HCV-RNA (log10 IU/ml)

    Highest HCV-RNA after Baseline (log10 IU/ml)

    Hepatitis flare

    1

    67

    Male

    1a

    Yes

    Hepatocellular carcinoma

    Nivolumab + ipilimumab

    5.45

    5.08

    Yes a

    2

    52

    Male

    1a

    No

    Melanoma

    Nivolumab + ipilimumab

    6.97

    6.95

    Yes b

    3

    57

    Male

    3

    No

    Melanoma

    Pembrolizumab

    5.72

    6.39

    No

    4

    55

    Male

    1a

    No

    Melanoma

    Ipilimumab

    5.75

    7.18 c

    Yes c

    a After partial hepatectomy.

    b Negative infectious work-up including hepatitis A, B, E, cytomegalovirus, and herpes simplex virus.

    c Six months after completing immunotherapy, HCV-associated hepatitis occurred after starting high-dose steroids for brain metastasis.

    Jeff Hosry, M.D.1,2, Aung Naing, M.D.3 and Harrys Torres, M.D.1,4, (1)Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, The University of Texas Health Science at Houston, Houston, TX, (3)Investigational Cancer Therapeutics , Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, (4)Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX

    Disclosures:

    J. Hosry, None

    A. Naing, None

    H. Torres, Gilead Sciences, Merck & Co., Inc.: Grant Investigator , Grant recipient . Vertex Pharmaceuticals: Grant Investigator , Grant recipient .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.