EGFR Exon 19 Deletion Mutation Patients Obtain Optimal Survival in Icotinib Treated Non e Small Cell Lung Cancer Patient with Brain Metastases

evaluate the incidence and characterize TEE in lung cancer patients treated with Nivolumab. Methods: This was a retrospective cohort study that included all lung cancer patients treated with Nivolumab from April 2015 to June 2016 at our institution. Medical records were reviewed for incidence, timing, CTCAE grade, type and site of TEE occurring after the initiation of Nivolumab. Prior chemotherapy, anticoagulation, baseline labs and patient demographics were also reviewed. Results: Of the 60 lung cancer patients who received Nivolumab, 29 (48.3%) were women and 31 (51.7%) were men with a median age of 63 years. All 60 patients had advanced stage lung cancer (stage IV, recurrent and residual). 24 of the 60 patients (40%) in the study had developed TEE since diagnosis of lung cancer, 41.7% (10/24) of which occurred after initiating Nivolumab. The incidence of TEE after starting Nivolumab was 16.7% (10/60), 6 (10%) deep vein thrombosis (DVT), 3 (30%) pulmonary embolism (PE) and 1 (10%) arterial thrombosis (AT), 2 (20%) recurrences and 1 (10%) concurrent. While 40% (4/10) of TEE occurring after starting Nivolumab were CTCAE grade 4 or higher, only 7% (1/14) of TEE prior to starting Nivolumab were CTCAE grade 4 of higher. In patients who developed TEE after starting Nivolumab, 40% (4/10) had previously received platinum based chemotherapy, 10% (1/10) VEGF inhibitor alone, 10% (1/10) platinum based with VEGF inhibitor and 10% (1/10) had received no chemotherapy. None of the 11 patients who were on systemic anticoagulation (LMWH, VKA, NOAC) and 2 of the 19 patients (10.5%) who were on Aspirin during Nivolumab therapy developed TEE. Conclusion: In Nivolumab treated lung cancer patients, the incidence of TEE is significantly high at 16.7%, likely due to advanced stage, prior chemotherapy and acquired autoimmunity during treatment. Further studies to assess the median duration to development of TEE and the role of prophylactic anticoagulation in lung cancer patients treated with Nivolumab are necessary.