Mycobacterial Infections due to PD-1 and PD-L1 Checkpoint Inhibitors

• 21 Sep 2020 09:14:46 AM
• |Onco Urology

Dear All,

We have been discussing on PD-1 and PD-L1 during our webinars adlib as a ‘ramban’ for treatment of Advanced GU cancers. This article being provided is a general article that indicates that Mycobacterial Infections, both TB and Atypical Mycobacterial Infections, can occur with usage of ICIs. In some instances mortality has also been recorded with Mycobacterial infections after use of ICIs. Though rare as of now, the reported incidences are increasing.

https://esmoopen.bmj.com/content/esmoopen/5/4/e000866.full.pdf

India is the hot seat of Tuberculosis and there appear that there is an increasing use of ICI’s in the treatment of many cancers.  This makes it necessary for us to be more vigilant when using ICI’s. The highest number of Mycobacterial Infections is recorded after use of these agents are for Lung Cancer. Use of ICI in GU cancers had a late start when compared to various other cancer subtypes with probably Kidney cancer leading the way. Nivolumab which is PD-1 led the way to be followed by other PD-L1 ICIs. The literature suggests that ICIs are less toxic than that are seen with other chemotherapeutic agents in common use. As mentioned, we in India with high TB burden should be extra vigilant regarding this when using ICIs. These agents are costly and less affordable for many financially strapped Indians as indicated in its pricing. Currently only 3 ICIs are approved by DGCI. They are Nivolumab, Atezolizumab and Pembrolizumab. The cost of drugs in Indian Rs varies depending on strength.

Nivolumab – Cost ranges from Rs 39000 for 40mg strength to Rs 96000 for 100 mg strength.

Atezolizumab – 1200mg, 20 Ml vial cost Rs 3 Lakhs

Pembrolizumab – Rs 1.2 lakh a vial, Rs 2.6 lakh for 100mg

The price appears to vary from Distributor to Distributor.

With warm Regards,

Venu

Comments(1)

• 

  Venugopal P

  21 Sep 2020 05:31:39 PM

  New Biomarkers for Checkpoint Inhibitor Therapy

  Dear All,

  We are in an era where Checkpoint inhibitors are being considered for several Solid Tumours with varying effect both in Adjuvant and Neoadjuvant settings. As mentioned earlier Checkpoint Inhibitors are being considered in almost all GU Cancers with varying outcomes.

  Even though these Agents have been found effective, it is not giving the response in all making it difficult to decide on whom to administer or on whom not to give. These treatments are expensive and by administering them for those in whom there may be no response, may not serve the purpose. Hence it has become necessary to understand on whom to administer and on whom not to. For this several biomarkers have been identified and this article addresses the usefulness of these biomarkers.

  https://esmoopen.bmj.com/content/esmoopen/5/Suppl_1/e000597.full.pdf

  Choosing the right patient is important especially in a financially strapped country like India.

  This is not a Urological oriented article but is an article to be understood if we are going tp place our patients on Immune Checkpoint Inhibitors.

  With warm Regards,

  Venu