5944 - Significance of severe immune-related adverse effects (irAE) on patients with advanced tumors treated with immune checkpoint inhibitors being admitted for secondary toxicity: Clinical relevance and next steps

Background

Disruption of the immune system using immune checkpoint inhibitors (ICI) can result in a multitude of immune-related adverse effects (irAE). While irAEs have been well-reported in clinical trials, the impact and magnitude in the real world is unclear.

Methods

Data was collected on patients with advanced malignancy who experienced a suspected irAE requiring admission to an academic hospital (02/11-10/18). Each case was comprehensively reviewed by a minimum of two reviewers, including one sub-specialist.

Results

From 2011-2018, there were 632 hospitalizations for suspected irAEs, and the majority (59.7%; N = 377) were confirmed irAEs from immunotherapy: PD1 (N = 194, 51.5%), CTLA4 (N = 92, 24.4%), CTLA4 + PD1 (N = 76, 20.2%), PLD1 (N = 15, 4.0%). The most common irAEs were gastrointestinal (37.4%), pulmonary (14.9%), hepatic (13.5%), endocrine (16.2%), neurologic (9.0%), cardiac (6.9%), dermatologic (5.6%), rheumatologic (2.9%), hematologic (2.1%), renal (1.9%), and allergy (1.1%). 10.3% of admissions had multiple toxicities. Median length of stay was 5 days (IQR, 3-8). Majority of patients (89.1%) required continuation of immunosuppressive medication on discharge. Inpatient toxicity led to ICI discontinuation in 78.1% of admissions. Overall, there were 11.3 irAE admissions per 100 patients treated with ICI and 2.1 irAE admissions per 100 ICI administrations.

Conclusions

irAEs from ICI can result in prolonged hospitalizations, need for immunosuppression, and ICI discontinuation, which can have detrimental effects on oncologic outcomes. Consequently, there is a critical need for coordinated multidisciplinary approach, comprehensive provider education, and translational research programs for early detection and intervention.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.