Bruyère Charline Lafayolle de la, Souquet Pierre-Jean, Dalle Stéphane, Corbaux Pauline, Boespflug Amélie, Duruisseaux Michaël, Kiakouama-Maleka Lize, Reverdy Thibaut, Maugeais Madeleine, Sahin Gulsum, Maillet Denis, Péron Julien
Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France.
Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.
Cancers (Basel). 2021 May 14;13(10):2365. doi: 10.3390/cancers13102365.
It remains unclear whether immune-related adverse events (irAEs) and glucocorticoid use could impact long-term outcomes in patients treated for solid tumors with immune checkpoint inhibitors (ICI). All patients treated with a single-agent ICI for any advanced cancer were included in this retrospective unicentric study. The objectives were to assess the impact of grade ≥3 irAEs, glucocorticoid use and the interruption of immunotherapy on progression-free survival (PFS) and overall survival (OS). In this 828-patient cohort, the first occurrence of grade ≥3 irAEs had no significant impact on PFS or OS. Glucocorticoid administration for the irAEs was associated with a significantly shorter PFS (adjusted HR 3.0; = 0.00040) and a trend toward shorter OS. ICI interruption was associated with a significantly shorter PFS (adjusted HR 3.5; < 0.00043) and shorter OS (HR 4.5; = 0.0027). Glucocorticoid administration and ICI interruption were correlated. In our population of patients treated with single agent ICI, grade ≥3 irAEs did not impact long-term outcomes. However, the need for glucocorticoids and the interruption of immunotherapy resulted in poorer long-term outcomes. The impact of grade ≥3 irAEs reported in other studies might then be explained by the management of the irAEs.
免疫相关不良事件（irAEs）和糖皮质激素的使用是否会影响接受免疫检查点抑制剂（ICI）治疗实体瘤患者的长期预后仍不清楚。本项回顾性单中心研究纳入了所有接受单药ICI治疗任何晚期癌症的患者。目的是评估≥3级irAEs、糖皮质激素的使用以及免疫治疗中断对无进展生存期（PFS）和总生存期（OS）的影响。在这个828例患者的队列中，首次出现≥3级irAEs对PFS或OS没有显著影响。因irAEs使用糖皮质激素与显著缩短的PFS（校正风险比3.0；P = 0.00040）以及OS缩短的趋势相关。ICI中断与显著缩短的PFS（校正风险比3.5；P < 0.00043）和缩短的OS（风险比4.5；P = 0.0027）相关。糖皮质激素的使用和ICI中断具有相关性。在我们接受单药ICI治疗的患者群体中，≥3级irAEs并未影响长期预后。然而，糖皮质激素的使用需求和免疫治疗的中断导致了较差的长期预后。其他研究中报道的≥3级irAEs的影响可能可以通过irAEs的管理来解释。
