Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
Oncologist. 2023 Oct 3;28(10):e950-e959. doi: 10.1093/oncolo/oyad135.
As immune checkpoint inhibitors (CPI) are increasingly approved for cancer treatment, hospitalizations related to severe immune-related adverse events (irAE) will increase. Here, we identify patients hospitalized due to irAEs and describe survival outcomes across irAE, CPI, and cancer type.
We identified patients hospitalized at our institution from January 2012 to December 2020 due to irAEs. Survival was analyzed using Kaplan-Meier survival curves with log-rank tests.
Of 3137 patients treated with CPIs, 114 (3.6%) were hospitalized for irAEs, resulting in 124 hospitalizations. Gastrointestinal (GI)/hepatic, endocrine, and pulmonary irAEs were the most common causes of irAE-related hospitalization. After CPI initiation, the average time to hospitalization was 141 days. Median survival from hospital admission was 980 days. Patients hospitalized due to GI/hepatic and endocrine irAEs had longer median survival than patients with pulmonary irAEs (795 and 949 days vs. 83 days [P < .001]). Patients with melanoma and renal cell carcinoma had longer median survival than patients with lung cancer (2792 days and not reached vs. 159 days [P < .001]). There was longer median survival in the combination group compared to the PD-(L)1 group (1471 vs. 529 days [P = .04]).
As CPI use increases, irAE-related hospitalizations will as well. These findings suggest that among patients hospitalized for irAEs, survival differs by irAE and cancer type, with worse survival for patients with irAE pneumonitis or lung cancer. This real-world data contributes to research pertaining to hospitalization due to severe irAEs, which may inform patient counseling and treatment decision-making.
随着免疫检查点抑制剂（CPI）在癌症治疗中的应用日益增多，与严重免疫相关不良事件（irAE）相关的住院治疗也会增加。在此，我们确定因 irAE 住院的患者，并描述不同 irAE、CPI 和癌症类型的生存结果。
我们确定了 2012 年 1 月至 2020 年 12 月期间因 irAE 在我院住院的患者。使用 Kaplan-Meier 生存曲线和对数秩检验分析生存情况。
在接受 CPI 治疗的 3137 例患者中，有 114 例（3.6%）因 irAE 住院，共发生 124 例住院事件。胃肠道（GI）/肝脏、内分泌和肺部 irAE 是 irAE 相关住院的最常见原因。在开始使用 CPI 后，平均住院时间为 141 天。从住院到死亡的中位生存时间为 980 天。因 GI/肝脏和内分泌 irAE 住院的患者比因肺部 irAE 住院的患者中位生存时间更长（795 天和 949 天 vs. 83 天[P<0.001]）。患有黑色素瘤和肾细胞癌的患者比患有肺癌的患者中位生存时间更长（2792 天和未达到 vs. 159 天[P<0.001]）。联合治疗组的中位生存时间长于 PD-（L）1 组（1471 天 vs. 529 天[P=0.04]）。
随着 CPI 使用的增加，irAE 相关的住院治疗也会增加。这些发现表明，在因 irAE 住院的患者中，生存情况因 irAE 和癌症类型而异，irAE 性肺炎或肺癌患者的生存情况更差。这些真实世界的数据有助于研究严重 irAE 相关的住院治疗，这可能为患者咨询和治疗决策提供信息。
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