86P - Treatment trajectories and outcome following irAE related hospitalization in metastatic cancer patients

Background

Immune-related adverse events (irAEs) are common side effects of immune checkpoint inhibitor (ICI) cancer therapy, affecting around 50% of the ICI treated patients. IrAEs may be severe and lead to hospitalization, permanent organ damage or the need for long-term immunosuppressants. Hospital admission is a generally known factor of poor prognosis, especially in older patients. This study aimed to investigate the clinical risk factors and prognostic significance of irAE-related hospitalization in metastatic real-world cancer patients.

Methods

The study population included all patients (n=202) with metastatic cancers treated with ICI inhibitors at the Cancer Center of Kuopio University Hospital between 2015 and 2023. Data were manually extracted from the local electronic patient registry. IrAEs, their management, hospital stays, subsequent therapies, progression-free survival (PFS) and overall survival (OS) were evaluated.

Results

Of the patients with irAEs, 26% (31/116) needed inpatient treatment. Hospitalization was associated with severe (grade III to IV) toxicities (p<0.001). The mOS of patients hospitalized due to an irAE was 12.9 months, while that of outpatients with irAEs was 26.9 months (p=0.006). The mOS was especially poor if hospital stay exceeded 6 days (7.0 months vs. 19.1 months, p=0.015). Systemic glucocorticoid therapy was administered to 90.3% of hospitalized and 35.3% of non-hospitalized patients (p<0.05). At disease progression after an irAE, palliative care instead of active oncological therapies was more often provided for hospitalized patients (35.4% vs. 17.6%, p=0.041). At the initiation of salvage systemic therapy after an irAE, hospitalized patients tended to be in poorer physical condition than outpatients (WHO performance status >2 in 35.7% vs. 14.6% of patients, p=0.089).

Conclusions

Hospital admission due to an irAE appeared to significantly deteriorate the survival of ICI treated metastatic cancer patients. This may be attributed to decreased physical fitness due to long admissions and high-dose, long-term glucocorticoid treatments of severe irAEs. Early rehabilitation and effective tapering of corticosteroid, if possible, should be provided for patients hospitalized due to an irAE.

Legal entity responsible for the study

Aino Rönkä.

Funding

State Research Funding for university-level health research, Kuopio University Hospital, Wellbeing Service Country of North Savo, Cancer foundation of Finland, Cancer Society of North Savo, The Finnish Medical Foundation sr, Paavo Koistinen Foundation.

Disclosure

All authors have declared no conflicts of interest.