Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
Br J Dermatol. 2021 Sep;185(3):627-635. doi: 10.1111/bjd.20074. Epub 2021 May 17.
Cutaneous immune-related adverse events (cirAEs) are a common side-effect of immune checkpoint inhibitors (ICIs). However, prior work examining these toxicities in detail has considered only the fraction of events evaluated by dermatologists. Associations between dermatology referral, cirAE treatment and survival outcomes remain underexplored across care settings.
To comprehensively categorize cirAE patterns among all patients treated with immunotherapy at our institution, and to evaluate: (i) the effect of dermatology referral on cirAE treatment and (ii) the impact of cirAE treatment on survival.
This was a retrospective cohort analysis of patients with cancer who initiated ICI therapy between 1 January 2016 and 8 March 2019 and developed one or more cirAEs, as screened for using International Classification of Diseases 10th revision codes and confirmed via manual chart review (n = 358). All relevant information documented prior to 31 March 2020 was included.
CirAEs evaluated by dermatologists were significantly more likely to be treated than cirAEs that were not referred (odds ratio 6·08, P < 0·001). Patients who received any cirAE treatment had improved progression-free survival [hazard ratio (HR) 0·59, P = 0·001] and overall survival (HR 0·58, P = 0·007) compared with those who did not.
CirAEs evaluated by dermatologists were significantly more likely to be treated than cirAEs that were not referred, and patients who received any treatment for a cirAE had improved survival outcomes.
皮肤免疫相关不良事件（cirAEs）是免疫检查点抑制剂（ICIs）的常见副作用。然而，之前详细研究这些毒性的工作只考虑了皮肤科医生评估的事件部分。在不同的治疗环境中，皮肤科转诊、cirAE 治疗与生存结局之间的关联仍未得到充分探讨。
全面分类本机构接受免疫治疗的所有患者的 cirAE 模式，并评估：（i）皮肤科转诊对 cirAE 治疗的影响；（ii）cirAE 治疗对生存的影响。
这是一项回顾性队列分析，纳入了 2016 年 1 月 1 日至 2019 年 3 月 8 日期间接受 ICI 治疗且出现 1 种或多种 cirAE 的癌症患者（n=358），通过国际疾病分类第 10 版代码筛查，通过手动图表审查确认。所有在 2020 年 3 月 31 日之前记录的相关信息均包括在内。
与未转诊的 cirAE 相比，皮肤科评估的 cirAE 更有可能得到治疗（优势比 6.08，P<0.001）。与未接受任何 cirAE 治疗的患者相比，接受任何 cirAE 治疗的患者无进展生存期（HR 0.59，P=0.001）和总生存期（HR 0.58，P=0.007）均得到改善。
与未转诊的 cirAE 相比，皮肤科评估的 cirAE 更有可能得到治疗，接受 cirAE 任何治疗的患者生存结局均得到改善。
