Lung Cancer Patients Hospitalized With irAEs Due to ICIs Have Shorter Survival

Lung cancer patients who have immune-related adverse events (irAEs) when treated with immune checkpoint inhibitors (ICIs) have worse survival outcomes than patients with other cancers who have irAEs on ICI treatment, according to a study published in The Oncologist.

The study also showed that patients with endocrine irAEs had the best survival outcomes, and patients with pulmonary irAEs had the worst survival outcomes.

The study included 3137 patients who were treated with ICIs from January 1, 2012, to December 31, 2020. The researchers examined survival data associated with patient hospitalizations in conjunction with irAE type, cancer type, and ICI type.

There were 124 hospitalizations that occurred among 114 of the patients, reflecting a cumulative incidence of 3.6% of the ICI-treated population. The most common cancer types in these patients were melanoma (34.2%), lung cancer (12.2%), renal cell carcinoma (9.6%), and head and neck cancer (7.0%). Most patients (90.3%) had metastatic or unresectable disease.

irAEs associated with hospitalization were most commonly gastrointestinal (41.1%), endocrine (12.9%), pulmonary (11.2%), or neurologic (7.2%). About 20% of irAEs were multisystem.

For all patients who were hospitalized due to irAEs, the median overall survival (OS) after hospitalization was 980 days. The 1-year OS rate was 63.2%, the 3-year OS rate was 46.5%, and the 5-year OS rate was 40.4%.

The 1-year OS was 87.5% for patients who had endocrine irAEs, 64.2% for those with gastrointestinal-related irAEs, 58.9% for patients with multisystem irAEs, and 28.6% for those with pulmonary irAEs. Of the patients with pulmonary irAEs, all but 1 had pneumonitis (n=13).

Across cancer types, the median OS from the time of hospitalization was longer for patients with renal cell carcinoma (not reached) or melanoma (2792 days) than for those with lung cancer (159 days; P <.001 overall). The 1-year OS rate was 83.3% for patients with melanoma, 83.3% for patients with renal cell carcinoma, and 28.1% for patients with lung cancer.

Patients receiving combination therapy had a longer median OS (1471 days) than patients receiving PD-1/PD-L1-directed monotherapy (529 days; P =.04). The median OS was not reached in patients treated with CTLA4-directed monotherapy. In patients with melanoma, ICI type was not associated with significant survival differences (P =.29).

“This real-world data can contribute to clinical models that assess the outcomes of hospitalization and the risk of death due to severe irAEs, which may inform patient counseling and treatment decision-making,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Silverstein J, Wright F, Wang M, et al. Evaluating survival after hospitalization due to immune-related adverse events from checkpoint inhibitors. Oncologist. Published online June 19, 2023. doi:10.1093/oncolo/oyad135