Approach Immune Checkpoint Inhibitor Rechallenge Cautiously After Initial Immune-Related Adverse Events

Use of standard treatment algorithms and careful monitoring may enable select patients with cancer to safely resume treatment with the same immune checkpoint inhibitor (ICI) after an immune-related adverse event (irAE), according to a new study published in JAMA Oncology.

Until now, little known was known about recurrence of an irAEs in patients rechallenged with the same immune checkpoint inhibitor that caused the irAE. Researchers conducted an observational, cross-sectional, pharmacovigilance study by reviewing individual case reports from VigiBase, the World Health Organization database that contains case reports from more than 130 countries. The researchers included in their analysis all consecutive immune checkpoint inhibitor cases from 1967 to September 1, 2019, with at least 1 associated irAE, and analyzed factors associated with irAE recurrence after rechallenge of the same ICI.

The team identified 24,079 irAE cases that were associated with at least 1 immune checkpoint inhibitor. The recurrence rate of the same irAE that prompted discontinuation of ICI therapy was 28.8% after a rechallenge with the same immune checkpoint inhibitor. Colitis (reporting odds ratio [OR], 1.77), hepatitis (reporting OR, 3.38), and pneumonitis (reporting OR, 2.26) were associated with a higher recurrence rate after rechallenge. Conversely, adrenal events were associated with a lower recurrence rate (reporting OR, 0.33) compared with other irAEs.

Reference

Dolladille C, Ederhy S, Sassier M, et al. Immune checkpoint inhibitor rechallenge after immune-related adverse events in patients with cancer. JAMA Oncol. doi: 10.1001/jamaoncol.2020.0726