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Published on: February 5, 2020
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Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma
1Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Summary
Delayed immune-related adverse events (irAEs) can occur over a year after starting anti-programmed cell death protein 1 (PD-1) therapy. These events, though infrequent, can be severe and require management, even after treatment cessation.
Area of Science:
- Oncology
- Immunology
- Clinical Medicine
Background:
- Immune-related adverse events (irAEs) are common during anti-programmed cell death protein 1 (PD-1)-based immunotherapy.
- While most irAEs occur within months, delayed irAEs (onset >12 months) are increasingly recognized.
- Understanding delayed irAEs is crucial for managing long-term cancer immunotherapy toxicity.
Purpose of the Study:
- To determine the incidence and characteristics of delayed irAEs in patients receiving anti-PD-1-based therapy.
- To describe the clinical presentation, management strategies, and outcomes of these delayed events.
- To evaluate the relationship between delayed irAEs and prior early irAEs.
Main Methods:
- Retrospective analysis of patients with delayed irAEs across 20 centers.
- Calculation of delayed irAE incidence in melanoma patients surviving >1 year on anti-PD-1 therapy.
- Examination of irAE onset, clinical features, treatments, and patient outcomes.
Main Results:
- An estimated 5.3% of patients experienced delayed irAEs, with a median onset of 16 months.
- Common delayed irAEs included colitis, rash, and pneumonitis; 39% were grade 3 or higher.
- Two deaths were attributed to irAEs, highlighting the potential severity.
Conclusions:
- Delayed irAEs represent a significant, albeit small, patient subset requiring careful monitoring.
- These events can differ from early irAEs, be severe, and occur even after treatment cessation.
- Consideration of delayed irAE risk is vital for treatment duration decisions and long-term patient management.
