Cancer Centre of Southeastern Ontario, Department of Oncology, Queen's University, Kingston, ON K7L 2V7, Canada.
Curr Oncol. 2020 Dec 2;28(1):52-59. doi: 10.3390/curroncol28010007.
Immune-related adverse events (iRAEs) are known complications of immune checkpoint inhibitors (ICIs). Early identification and management leads to improved morbidity and mortality. This study seeks to address our center's experience with iRAEs in the emergency department (ED).
We performed a retrospective review of patients treated with ICIs in 2018 and 2019 for any indication. All diagnoses of iRAEs were recorded. For all patients who presented to the ED following administration of an ICI, we assessed whether the presenting symptoms were eventually diagnosed as an iRAE. We assessed disposition, time to initiation of corticosteroids and outcomes in these patients.
351 evaluable patients were treated with an ICI, 129 patients (37%) had at least one presentation to the ED, 17 of whom presented with symptoms due to a new iRAE. New iRAE diagnoses were broad, occurred after median 2 cycles, majority irAEs were grade 3 or higher (70.6%), and two patients died due to toxicity. Twelve patients were admitted to the hospital during initial presentation or at follow-up, four required ICU care. All patients required immunosuppressive therapy, and only three were later re-challenged with an ICI. Of the patients who were admitted to the hospital, median time to first dose of corticosteroid was 30.5 h (range 1-269 h).
Patients on ICI have a significant risk of requiring an ED visit. A notable proportion of iRAEs have their first presentation at the ED and often can present in a very nonspecific manner. A standardized approach in the ED at the time of presentation may lead to improved identification and management of these patients.
免疫相关不良反应（irAEs）是免疫检查点抑制剂（ICIs）的已知并发症。早期识别和管理可改善发病率和死亡率。本研究旨在探讨我们中心在急诊科（ED）中治疗 irAEs 的经验。
我们对 2018 年和 2019 年因任何适应症接受 ICIs 治疗的患者进行了回顾性研究。记录所有 irAEs 的诊断。对于所有在接受 ICI 治疗后到 ED 就诊的患者，我们评估了其就诊症状最终是否被诊断为 irAE。我们评估了这些患者的处置、开始使用皮质类固醇的时间和结局。
351 例可评估患者接受了 ICI 治疗，129 例（37%）至少有一次 ED 就诊，其中 17 例因新的 irAE 出现症状。新的 irAE 诊断广泛，发生在中位数 2 个周期后，大多数 irAEs 为 3 级或更高（70.6%），有 2 例患者因毒性死亡。12 例患者在初次就诊或随访期间住院，4 例需要 ICU 护理。所有患者均需要免疫抑制治疗，只有 3 例患者后来再次接受了 ICI 治疗。在住院的患者中，首次使用皮质类固醇的中位数时间为 30.5 小时（范围 1-269 小时）。
接受 ICI 治疗的患者有很大的风险需要 ED 就诊。相当一部分 irAEs 的首次就诊是在 ED，并且通常表现非常不特异。在 ED 就诊时采用标准化方法可能会提高这些患者的识别和管理水平。
