89P - Safety and efficacy of rechallenge with immune checkpoint inhibitors in advanced solid tumor: A systematic review and meta-analysis

Background

Immune checkpoint inhibitors (ICIs) have drastically shifted the current landscape for a wide variety of malignancies. However, ICIs are interrupted due to immune-related adverse events (irAEs), therapy completion or disease progression. The risk-benefit of rechallenged ICIs remains inconclusive. Herein, a systematic review and meta-analysis were conducted to evaluate the safety and efficacy of ICIs rechallenge in advanced solid tumor.

Methods

PubMed, Web of Science, Embase and Cochrane library were searched for analyzing the efficacy and safety of ICIs rechallenge. We prospectively registered the protocol in PROSPERO International Register of Systematic Reviews (CRD42022372222). The last update search date was March 2nd, 2024. Objective response rates (ORR), disease control rates (DCR), overall survival (OS) and the incidence rates of all-grade and high-grade irAEs were evaluated.

Results

A total of 41 retrospective studies comprising 2343 patients were ultimately enrolled for qualitative and quantitative assessment. 1200 (51.2%) individuals were male and the median age was 66 years, ranged from 18 to 97 years. The majority of tumor types were lung cancer (n=898, 38.3%). The occurrence rates of all-grade and high-grade (grade 3 or 4) irAEs between ICIs initial and readministration were not different significantly (all-grade: OR, 0.75, 95% CI: 0.39–1.45, p=0.40; I² =87%; high-grade: OR, 0.96, 95% CI: 0.62–1.49, p=0.87, I² =65%). ICIs restart presented a decreased ORR and DCR compared to initial ICIs administration (ORR: OR, 0.36, 95% CI: 0.23–0.56, p<0.00001; I² =67%; DCR: OR, 0.62, 95% CI: 0.43–0.89, p=0.010; I² =53%). Seven studies with 513 patients for survival analysis revealed a non-significantly different OS between ICIs rechallenge and discontinuation cohorts (HR: 0.68, 95% confidence interval (CI): 0.35 to 1.35, p=0.27).

Conclusions

It is feasible to rechallenge immunotherapy, while patients should be carefully evaluated by a multidisciplinary team for close monitoring and assessment of the risk-benefit ratio, prior to initial therapy. It is greatly essential to perform prospective trials to guide clinicians to make decisions.

Legal entity responsible for the study

The author.

Funding

Health Commission of Anhui Province Scientific Research Project (NO.AHWJ2023BAc10031 and AHWJ2023A30183).

Disclosure

The author has declared no conflicts of interest.