TY - JOUR
T1 - The feasibility and safety of surgery in patients receiving immune checkpoint inhibitors
T2 - A retrospective study
AU - Elias, Alexandra W.
AU - Kasi, Pashtoon M.
AU - Stauffer, John A.
AU - Thiel, David D.
AU - Colibaseanu, Dorin T.
AU - Mody, Kabir
AU - Joseph, Richard W.
AU - Bagaria, Sanjay P.
N1 - Publisher Copyright:
© 2017 Elias, Kasi, Stauffer, Thiel, Colibaseanu, Mody, Joseph and Bagaria.
PY - 2017/6/12
Y1 - 2017/6/12
N2 - Immune checkpoint inhibitors (ICI) are revolutionizing care for cancer patients. The list of malignancies for which the Food and Drug Administration is granting approval is rapidly increasing. Furthermore, there is a concomitant increase in clinical trials incorporating ICI. However, the safety of ICI in patients undergoing surgery remains unclear. Herein, we assessed the safety of ICI in the perioperative setting at a single center. We conducted a retrospective review of patients who underwent planned surgery while receiving ICI in the perioperative setting from 2012 to 2016. We collected 30-day postoperative morbidity and mortality utilizing the Clavien-Dindo classification system. We identified 17 patients who received perioperative ICI in 22 operations. Patients were diagnosed with melanoma (n = 14), renal cell carcinoma (n = 2), and urothelial carcinoma (n = 1). Therapies included pembrolizumab (n = 10), ipilimumab (n = 5), atezolizumab (n = 5), and ipilimumab/nivolumab (n = 2). Procedures included cutaneous/subcutaneous resection (n = 6), lymph node resection (n = 5), small bowel resection (n = 5), abdominal wall resection (n = 3), other abdominal surgery (n = 3), orthopedic surgery (n = 1), hepatic resection (n = 1), and neurosurgery (n = 2). There were no Grade III-IV Clavien-Dindo complications. There was one death secondary to ventricular fibrillation in the setting of coronary artery disease. ICI appear safe in the perioperative setting, involving multiple different types of surgery, and likely do not need to be stopped in the perioperative setting. Further studies are warranted to confirm these findings.
AB - Immune checkpoint inhibitors (ICI) are revolutionizing care for cancer patients. The list of malignancies for which the Food and Drug Administration is granting approval is rapidly increasing. Furthermore, there is a concomitant increase in clinical trials incorporating ICI. However, the safety of ICI in patients undergoing surgery remains unclear. Herein, we assessed the safety of ICI in the perioperative setting at a single center. We conducted a retrospective review of patients who underwent planned surgery while receiving ICI in the perioperative setting from 2012 to 2016. We collected 30-day postoperative morbidity and mortality utilizing the Clavien-Dindo classification system. We identified 17 patients who received perioperative ICI in 22 operations. Patients were diagnosed with melanoma (n = 14), renal cell carcinoma (n = 2), and urothelial carcinoma (n = 1). Therapies included pembrolizumab (n = 10), ipilimumab (n = 5), atezolizumab (n = 5), and ipilimumab/nivolumab (n = 2). Procedures included cutaneous/subcutaneous resection (n = 6), lymph node resection (n = 5), small bowel resection (n = 5), abdominal wall resection (n = 3), other abdominal surgery (n = 3), orthopedic surgery (n = 1), hepatic resection (n = 1), and neurosurgery (n = 2). There were no Grade III-IV Clavien-Dindo complications. There was one death secondary to ventricular fibrillation in the setting of coronary artery disease. ICI appear safe in the perioperative setting, involving multiple different types of surgery, and likely do not need to be stopped in the perioperative setting. Further studies are warranted to confirm these findings.
KW - Cancer
KW - Immune checkpoint inhibitors
KW - Morbidity
KW - Serious adverse events
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85020874988&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020874988&partnerID=8YFLogxK
U2 - 10.3389/fonc.2017.00121
DO - 10.3389/fonc.2017.00121
M3 - Article
AN - SCOPUS:85020874988
SN - 2234-943X
VL - 7
JO - Frontiers in Oncology
JF - Frontiers in Oncology
IS - JUN
M1 - 121
ER -