Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer.

BACKGROUND

Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments.

PATIENTS AND METHODS

The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted.

RESULTS

Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis.

CONCLUSION

Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types.

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure DP: research grant: MSDAVENIR; honoraria: Roche, BMS, MSD, AstraZeneca; travel: AstraZeneca. AF: grants, personal fees and nonfinancial support from ROCHE, AZ, Pfizer, MSD, BMS. JF: grants, personal fees and nonfinancial support from AZ, MSD, BMS, Merck Serono, Biogen, Rakuten, Roche, Servier. OT: Roche, AstraZeneca, Novartis, Pfizer, MSD, BMS, Sandoz. HB received travel expenses from BMS, Pfizer and honoraria from BMS and Pfizer. MP: grants, personal fees and nonfinancial support from Roche, Genentech, Eli Lilly, Pfizer, Boehringer-Ingelheim, MSD, Bristol-Myers Squibb, Novartis, Pierre Fabre, AstraZeneca, Takeda, Chugai, Amgen (adboards and symposiums). TB: advisory board and travel from Roche, Novartis, AstraZeneca, Pfizer and Seattle Genetics. PC: Roche/Genentech, AZ, Amgen, EMD/Merck Serono, Novartis (symposiums/adboard). VA: honoraria for advisory boards from Bristol-Myers Squibb. E-MN-B received travel expenses and honoraria from MSD, BMS, Pierre Favre and Novartis. FN: grants, personal fees and nonfinancial support from Novartis, Incyte Biosciences, Sun Pharma Ltd., Ylang Pharma Inc. AS received honoraria for advisory boards from Roche, Bristol-Myers Squibb; symposiums: Roche, AstraZeneca, Bristol-Myers Squibb. PS: Research grant from BMS and Roche. PM declares to have interest in NETRIS Pharma as founder and minority shareholder. IR-C: honoria from AbbVie, Agenus, Advaxis, BMS, Pharma Mar, Genmab, Pfizer, AstraZeneca, Roche, GSK, MSD, Deciphera, Mersena, Merck Sereno, Novartis, Amgen, Tesaro and Clovis; advisory/consultancy from AbbVie, Agenus, Advaxis, BMS, Pharma Mar, Genmab, Pfizer, AstraZeneca, Roche/Genentech, GSK, MSD, Deciphera, Mersena, Merck Sereno, Novartis, Amgen, Tesaro and Clovis; research grant from MSD, Roche and BMS. JYB: research support and honoraria from Roche, MSD, BMS, Bayer, Novartis, GSK, AstraZeneca. The remaining authors declare no conflicts of interest.