Predictors of immunotherapy-induced immune-related adverse events

Purpose We aimed to elucidate predictive factors for the development of immune-related adverse events (irAES) in patients receiving immunotherapies for the management of advanced solid cancers. Methods This retrospective study involved all patients with histologically confirmed metastatic or inoperable melanoma, non-small-cell lung cancer, or renal cell carcinoma receiving immunotherapy at the Cancer Centre of Southeastern Ontario. The type and severity of irAEs, as well as potential protective and exacerbating factors, were collected from patient charts. Results The study included 78 patients receiving ipilimumab (32%), nivolumab (33%), or pembrolizumab (35%). Melanoma, non-small-cell lung cancer, and renal cell carcinoma accounted for 70%, 22%, and 8% of the cancers in the study population. In 41 patients (53%) irAEs developed, with multiple irAEs developing in 12 patients (15%). In most patients (70%), the irons were of severity grade 1 or 2. Female sex [adjusted odds ratio (ORadj): 0.094; 95% confidence interval (CI): 0.021 to 0.415; p = 0.002] and corticosteroid use before immunotherapy (ORadj: 0.143; 95% CI: 0.036 to 0.562; p = 0.005) were found to be associated with a protective effect against irAEs. In contrast, a history of autoimmune disease (ORadj: 9.55; 95% CI: 1.34 to 68.22; p = 0.025), use of CTLA-4 inhibitors (ORadj: 6.25; 95% 1.61 to 24.25; p = 0.008), and poor kidney function of grade 3 or greater (ORadj: 10.66; 95% CI: 2.41 to 47.12; p = 0.025) were associated with a higher risk of developing irAEs. A Hosmer-Lemeshow goodness-of-fit test demonstrated that the logistic regression model was effective at predicting the development of irAEs (chi-square: 1.596; df = 7; p= 0.979). Conclusions Our study highlights several factors that affect the development of irAEs in patients receiving immunotherapy. Although future studies are needed to valid ate the resulting model, findings from the study can help to guide risk stratification, monitoring, and management of irAEs in patients given immunotherapy for advanced cancer.