Impact of Immune-Related Adverse Events on Immune Checkpoint Inhibitors Treated Cancer Patients' Survival: Single Center Experience and Literature Review

Simple Summary The widespread use of immune checkpoint inhibitors (ICI) came along with a new challenge for oncologists, immune-related adverse events (irAE). A positive correlation between irAE onset and ICI efficacy has been suggested. However, it remains unsettled. Whether the association exists and if it is affected by cancer type or ethnicity needs further investigation. This study provides additional evidence to support this association by using a retrospective, single-center cohort design to analyze survival outcomes and the development of irAEs of 155 patients. Overall, the study offers new insights into the potential use of irAEs as biomarkers for response and survival in solid tumor patients receiving ICIs, and highlights the need for further research in this area. Immune-related adverse events have emerged as a new challenge and its correlation with survival remains unclear. The goal of our study was to investigate the effect of irAE on survival outcomes in solid tumor patients receiving ICI treatment. This was a retrospective, single-center study at a university hospital involving patients with malignancy who received immune checkpoint inhibitors. Chart review was performed on each patient, noting any irAE, including new events or worsening of previous autoimmune condition after starting treatment with ICI. A total of 155 patients were included, 118 (76.1%) were male, with median age of 64 years. Median follow up time was 36 months. Seventy patients (45.2%) had at least one irAE. Of all irAE, nine (8.1%) were classified as grade 3 or higher according to the CTCAE version 5.0. There was one death secondary to pneumonitis. Median ICI cycles until first irAE onset was 4 (range: 2-99). The objective response rate was higher for patients who developed irAE (18.7% vs. 9.0%; p = 0.001), as was median overall survival (18 months (95% CI, 8.67-27.32) vs. 10 (95% CI, 3.48-16.52) months; p < 0.016) and progression free survival (10 months (95% CI, 5.44-14.56) vs. 3 months (95% CI, 1.94-4.05); p = 0.000). The risk of death in patients with irAE was 33% lower when compared to patients without such events (hazard ratio (HR): 0.67; 95% CI, 0.46-0.99; p = 0.043). Development of irAE predicted better outcomes, including OS in patients with advanced solid tumors treated with ICI. Further prospective studies are needed to explore and validate this prognostic value.

Automated summary

The use of immune checkpoint inhibitors (ICI) presents a new challenge for oncologists, namely immune-related adverse events (irAE). The correlation between irAE onset and ICI efficacy is still unclear. This study provides further evidence to support this association and highlights the need for additional research in this area.