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Cutaneous Immune-Related Adverse Events and Efficacy of Immune Checkpoint Inhibitors for Patients With Advanced Solid
David O'Reilly1,2, Gregg Murray3, Orla M Fitzpatrick1
1Medical Oncology, Beaumont RCSI Cancer Centre, Dublin, Ireland.
Introduction:
Immune checkpoint inhibitors (ICIs) have significantly improved outcomes for patients with advanced solid tumors. While low-grade immune-related adverse events (irAEs) are associated with prolonged survival, high-grade irAEs have been associated with poorer survival. Cutaneous immune-related adverse events (cirAEs) affect up to 20%-40% of patients treated with ICIs. We investigated the association between cirAES and the outcomes of progression-free survival (PFS) and overall survival (OS) in advanced solid organ malignancies.
Methods:
A retrospective analysis of patients receiving ICIs for stage IV solid organ malignancies was conducted at Beaumont RCSI Cancer Centre, Dublin, Ireland, between January 1, 2012, and June 30, 2020. Eligible participants included those who commenced therapy during this period, having received at least one cycle of ICI treatment, with or without chemotherapy, for histologically confirmed advanced solid organ malignancies.
Results:
Among 278 analyzed patients, 19% (53/278) experienced any cirAES. The most common cirAEs included psoriasis (23%) and pruritus (15%). cirAES were associated with significantly improved PFS (median 47.3 months vs. 18.3 months, p < 0.01) and OS (median 60.0 months vs. 26.0 months, p < 0.01). Patients with prior systemic therapy had a decreased risk of cirAES (odds ratio = 0.44, p = 0.02), and multivariate analysis confirmed that cirAES was independently associated with improved PFS and OS.
Conclusion:
Our study supports that cirAES may be associated with improved patient outcomes and that prior systemic therapy may be associated with a reduced risk of cirAES. Future research should focus on multi-institutional collaborations based on prospective irAE data to better understand the impact of specific irAEs on clinical outcomes.
Insights
Cutaneous immune-related adverse events (cirAEs) in patients receiving immune checkpoint inhibitors (ICIs) are linked to better progression-free survival and overall survival. Prior systemic therapy may reduce the risk of developing cirAEs.
Area of Science:
- Oncology
- Immunology
- Dermatology
Background:
- Immune checkpoint inhibitors (ICIs) have transformed advanced solid tumor treatment.
- Immune-related adverse events (irAEs) can impact patient outcomes, with high-grade irAEs potentially worsening survival.
- Cutaneous irAEs (cirAEs) are common, affecting 20-40% of patients on ICIs.
Purpose of the Study:
- To investigate the association between cirAEs and clinical outcomes in advanced solid organ malignancies.
- To determine the impact of cirAEs on progression-free survival (PFS) and overall survival (OS).
Main Methods:
- Retrospective analysis of 278 patients treated with ICIs at Beaumont RCSI Cancer Centre (2012-2020).
- Inclusion criteria: Stage IV solid organ malignancies, at least one ICI cycle, with or without chemotherapy.
- Data collected on cirAE occurrence and patient survival outcomes.
Main Results:
- 19% of patients experienced cirAEs, most commonly psoriasis and pruritus.
- cirAEs were significantly associated with improved PFS (47.3 vs. 18.3 months) and OS (60.0 vs. 26.0 months).
- Prior systemic therapy correlated with a reduced risk of cirAEs (OR=0.44, p=0.02); cirAEs independently predicted better PFS and OS.
Conclusions:
- cirAEs may indicate improved outcomes for patients with advanced solid organ malignancies treated with ICIs.
- Previous systemic therapy might decrease the likelihood of developing cirAEs.
- Future research should involve multi-institutional prospective studies on irAE data to clarify specific irAE impacts.
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