The Effect of Nivolumab in Pediatric Malignant Tumors: A Single Center Experience with Nine Children

Abstract

Nivolumab is an inhibitor of programmed cell death 1 (PD-1), which enables activated T cells to attack the tumor cells. Although the utilization of nivolumab in adulthood cancers is more common, experience in childhood has been increasing recently. Herein, pedi- atric cases received nivolumab for distinct cancers are presented. The data of nine patients under the age of 18 years who received nivolumab for various cancers in the Pediatric Oncology clinic between January 2019-December 2022 were obtained. Nivolumab was administered intravenously at a dose of 3 mg/kg with 30 minutes infusion every two weeks. Patients’ clinical, cancer types, response to primary treatment, comorbidities, and outcomes of nivolumab were evaluated. Nivolumab was utilized for non-Hodgkin lymphoma, classical Hodgkin lymphoma (cHL), central nervous system, germ cell and gastrointestinal system cancers. Four out of nine pa - tients had constitutional mismatch repair deficiency (CMMRD) syndrome and 2/4 patients developed secondary cancers during the nivolumab. The median dose and duration of nivolumab were 10 doses (4-32 doses) and 6 months (2 to 17 months), respectively. The median follow-up period was 25 months (2-46 months). Nivolumab achieved progression free survival in immature teratoma, cHL and T-Lymphoblastic lymphoma (T-LBL) with 46 months, 22 months, and 31 months, respectively. Only one patient had severe generalize edema attributed to nivolumab. We observed that although encouraging outcomes with nivolumab in cHL, immature teratoma and T-LBL, it failed to prevent glioblastoma progression in children with CMMRD. In summary, nivolumab may be effective in selected childhood cancers.