Efficacy of checkpoint inhibitors in hospitalized patients with cancer

e14687 Background: Pembrolizumab is approved by FDA in 2014 to treat metastatic melanoma. Use of immune check point inhibitors (ICI) has been expanding in multiple cancer types including non-small cell lung cancer since then. In this mini case series, we will evaluate the benefits and risks of immunotherapy in hospitalized patients. Use of immunotherapy agents in inpatient unit has been associated with poor clinical outcome and higher cost. Byrne et. al have recently shown that more than 45% of hospitalized patients receiving PD1 or PD-L1 antibodies have either died or discharged to hospice care. A large retrospective chart review in Dana Farber Cancer Institute reveals 86% mortality rate in hospitalized immunotherapy recipients within the study period. Understanding the safety and advantages of using immune checkpoint inhibitors in inpatient unit has a pivotal role in decreasing the healthcare associated costs and setting the appropriate goals of care with patients and families. Methods: This is a retrospective observational cohort study conducted by review of electronic health records in last 5 years (from January 1 st 2017- January 1 st 2022) in Rutgers Health Community Medical Center and Monmouth Medical Center. Adult patients admitted to inpatient unit who received Pembrolizumab, Atezolizumab, or Nivolumab were included. Results: A total of 61 patients has received ICI therapy while in hospital with 57% males and 42% female. All patients had solid tumors, with most common malignancy being lung cancer (55%) followed by colon cancer (14%). Most common ICI given was pembrolizumab (62%) followed by atezolizumab (18%) and Nivolumab (16%). 26% of patients that were treated died in the hospital, 35% were transferred to another care facility and 29% were discharged home. No immune-related adverse events were reported. Age groups, cancer types were comparable with regard to discharge status. Conclusions: Poor mortality and survival outcome from this case series should prompt clinicians to consider benefit and risks of ICI therapy when prescribed to patients who were hospitalized for non-oncological acute conditions.