Checkpoint Inhibitors Appear Safe for Pediatric Cancer Patients

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The efficacy of checkpoint inhibitors in pediatric cancer therapy has been limited.
The efficacy of checkpoint inhibitors in pediatric cancer therapy has been limited.
The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage. 

CHICAGO — Checkpoint inhibitors so far have shown little efficacy in the treatment of pediatric cancers, but new studies presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting contribute to a better understanding of how these drugs work in children and perhaps point the way to using the agents more effectively in this population, according to David M. Barrett, MD, PhD, a pediatric oncologist at the Children's Hospital of Philadelphia. 1-3

In a session at the conference, Dr Barrett reviewed 3 phase 1/2 studies of checkpoint inhibitor use in pediatric cancer patients. One study examined nivolumab and ipilimumab use in pediatric patients with relapsed/refactory solid tumors. Another study looked at the effect of atezolizumab in pediatric and young adult patients with refractory or relapsed solid tumors. A third study examined the use of pembrolizumab in pediatric patients with advanced melanoma or a PD-L1+ advanced, relapsed, or refractory solid tumor of lymphoma.

“These agents are powerful, these agents are promising,” Dr Barrett, assistant professor of pediatrics at the University of Pennsylvania's Perelman School of Medicine, told attendees. “We haven't seen activity in pediatrics yet, but I think we need to be better about how we characterize them. These trials are very important because they show that we can use these agents and dose them [in children].”

Now researchers can focus more on using checkpoint inhibitors in clinical situations where they are likely to have the greatest effect and explore ways to modify the tumor environment such that these agents will have an effect, he said.

As single agents, checkpoint inhibitors show little efficacy, he said, but it is possible that using these drugs in combination could lead to better stimulation of the immune system.

The studies show that the medications are associated with few adverse events, Dr Barrett said. The drugs also have pharmacokinetic profiles similar those of adult patients, which is important for effective dosing in children, he said. Use of the agents in children does not appear to cause autoimmune disease or autoimmune findings, treatment effects that have been observed in adults.

Read more of Oncology Nurse Advisor's coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

References

1. Geoerger B, Karski EE, Zwaan M, et al. A phase I/II study of atezolizumab in pediatric and young adult patients with refractory/relapsed solid tumors (iMATRIX-Atezolizumab). J Clin Oncol. 2017;35(suppl):abstr 10524.

2. Geoerger B, Kang HJ, Yalon-Oren M, et al. Phase ½ KEYNOTE-051 study of pembrolizumab (pembro) in pediatric patients (pts) with advanced melanoma or a PD-L1+ advanced, relapsed, or refractory solid tumor or lymphoma. J Clin Oncol. 2017;35(suppl):abstr10525.

3. Davis KL, Fox E, Reid JM, et al. ADVL 1412: initial results of a phase I/II study of nivolumab and ipilimumab in pediatric patients with relapsed/refractory solid tumors — a COG study. J Clin Oncol. 2017;35(suppl):abstr10526.

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