A retrospective study of immune-related adverse events in various solid tumors

Abstract

Background: Immune checkpoint inhibitors (ICIs) have been approved in various type of cancers. Although ICIs are less toxic than cytotoxic chemotherapy, they cause various immune-related adverse events (irAEs). A cooperation with experts is needed to diagnose and treat irAEs properly. The aim of this study was to evaluate frequency and management of irAEs in a real-world practice. Methods: We conducted a retrospective study of patients(pts) who received ICIs (ipilimumab, nivolumab, pembrolizumab, atezolizumab or avelumab) at Keio university hospital between September 2014 and January 2019. Treatment-related AEs were retrospectively evaluated from medical records and graded using Common Terminology Criteria for Adverse Events version 4. Results: ICIs were administered in 299 pts with lung cancer (n=123), malignant melanoma (n=63), renal cell carcinoma (n=37), gastric cancer (n=29), head and neck cancer (n=26), urothelial cancer (n=19), Merkel cell carcinoma and microsatellite instability-high ovary cancer (n=1). A total of 209 pts experienced any grade of AEs. In 60 pts experienced grade ≥3 AEs, pneumonitis and ALT increased (5.3%) were most frequently identified, followed by adrenal insufficiency (3.0%) and diarrhoea (2.7%). No cancer-type specific tendency was observed. Pts who were treated with ipilimumab experienced ≥3 AEs more frequently than those with anti-PD1 antibodies (p=0.0003). Regarding the treatment to grade ≥3 AEs, all pts with pneumonitis received therapeutic intervention by respiratory physicians. Although only 63% of diarrhoea and 50% of ALT increased pts had an examination by gastroenterologists or hepatologists, those who needed immunosuppressive treatment were supported by experts appropriately. Conclusions: The incidence of ICI-related AEs in our hospital was comparable to previous reports. The cooperation with experts for irAEs would be important for proper management of irAEs.