Background: Grade 3 and 4 immune related adverse events (irAEs) require use of significant dose of corticosteroids and immunosuppressive agents. Using corticosteriods equivalent to 16–25 mg prednisolone or 4 mg dexamethasone for 4 weeks put patients at risk of developing PJP.1 However, it is unclear if using corticosteroids for irAEs has same risk for PJP compared with immunosuppression for other clinical indications as number of case reports for PJP in irAE treatment is very small on literature review.
Aim: This study aims to examine the adherence to PJP prophylaxis and risk of PJP development in patients who required immunosuppressive treatment for irAEs in Cairns and Hinterland Hospital and Health Services (CHHHS).
Methods: A retrospective single-centre review on patients receiving ICI for advanced cancers from 2015 to 2019. Electronic records of eligible patients were reviewed for development of grade 3 and 4 irAEs, treatment with immunosuppression and whether they were prescribed PJP prophylaxis as per current New South Wales Cancer Institute site eviQ recommendations (i.e. ≥20mg of prednisolone daily or ≥4mg dexamethasone daily for ≥4weeks).
Results: Out of 170 patients, 20 patients (11.76 %) were treated with immunosuppressive treatment for irAEs that meets recommendation for PJP prophylaxis. 17 out of 20 patients (85%) were given PJP prophylaxis while 3 patients (15%) were not. None of the 20 patients were subsequently diagnosed with PJP until study censored date of 22/06/2020.
Conclusion: This study provides an insight into current practice at CHHHS in immunotherapy delivery, risk of PJP with ICI treatment and PJP prophylaxis adherence to current recommendations. Although risk of PJP in the setting of irAE management is low, we recommend assessing risk of PJP in all patients requiring immunosuppression for irAEs and prescribed as per current recommendations unless there are other clinical considerations such as drug interactions or contraindications.