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Published on: February 5, 2020
Emergency Care for Patients with Cancer on Immune Checkpoint Inhibitors: A Retrospective Analysis of Immune-Related
Alice Ferrua1, Jacopo Davide Giamello2, Chiara Fulcheri2
1Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy; Department of Internal Medicine, Santa Croce e Carle Hospital, Cuneo, Italy.
Background:
Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, but can lead to immune-related adverse events (irAEs), some of which require emergency care.
Objective:
To evaluate the prevalence, clinical features and outcomes of emergency department (ED) visits related to irAEs among patients receiving ICIs.
Methods:
We retrospectively reviewed ED visits from 2013 to 2021 among patients with solid tumors treated with ICIs at a single tertiary cancer center in Italy. Each visit was independently reviewed and classified as definitely, potentially, or not related to irAEs.
Results:
Of 457 ED visits from 216 patients, 27 (5.9%) were definitely and 15 (3.3%) potentially related to irAEs. The most frequent irAEs were pneumonitis (n = 19), colitis (n = 5), and hepatitis (n = 3). Dyspnea was more common in irAE-related visits (28.6% vs 13%, p = 0.006). 74.1% of irAE-related visits resulted in hospital admission and 30-day mortality was 14.3%. The median time from ICI initiation to ED presentation for irAEs was 21 weeks.
Conclusions:
irAEs account for a significant portion of ED visits in patients receiving ICIs, with pneumonitis being the most frequent. Emergency clinicians should be aware of this delayed toxicity spectrum, especially in patients presenting with respiratory symptoms.
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