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Abstract: PO2164

Electrolyte Abnormalities in Patients Receiving Immune Checkpoint Inhibitors

Session Information

  • Onco-Nephrology - 1
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Rusibamayila, Nifasha, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Chute, Donald F., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Lee, Meghan, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Strohbehn, Ian Austin, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Faje, Alexander, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Reynolds, Kerry, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Jhaveri, Kenar D., Northwell Health, Great Neck, New York, United States
  • Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Hyponatremia due to endocrinopathies such as adrenal insufficiency and hypothyroidism has been reported in patients receiving immune checkpoint inhibitors. Other electrolyte abnormalities such as hypocalcemia and hypokalemia have also been associated with the use of these agents. We study the incidence and predictors of electrolyte abnormalities in cancer patients receiving immune checkpoint inhibitors.

Methods

Patients who received immune checkpoint inhibitors at Massachusetts General Hospital Cancer Center between 2011 and 2018 were included. Incidence of electrolyte abnormalities were determined in the first 12 months after drug initiation and graded for severity by using Common Terminology for Cancer Adverse Events criteria. The predictors of severe electrolyte abnormalities were determined using a multivariable logistic regression model.

Results

We analyzed 2458 patients started on checkpoint inhibitors in our cancer center. Average age was 64 (SD 13) years, 58% were male and 90% were White. In the first year of follow-up, 62% experienced hyponatremia, 27% had hypokalemia, 26% had hyperkalemia, 49% had hypophosphatemia and 9% had hypocalcemia. Grade 3 or 4 hyponatremia was seen in 136 patients (6%) and occurred 164 days (SD 100) after checkpoint inhibitor initiation; only 9 cases of grade 3 or 4 hyponatremia were due to endocrinopathies. CTLA4 inhibitors were associated with a higher risk of grade 3 or 4 hyponatremia and hypophosphatemia. Patients with gastrointestinal malignancies experienced the highest risk of grade 3 or 4 electrolyte abnormalities.

Conclusion

Electrolyte abnormalities are common in cancer patients receiving immune checkpoint inhibitors. Endocrinopathies leading to severe hyponatremia are rare (<0.5%).

Funding

  • NIDDK Support