Department of Medicine, Salem Hospital, Salem, MA, United States.
Mass General Cancer Center, Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
Oncologist. 2024 Nov 4;29(11):e1615-e1620. doi: 10.1093/oncolo/oyae189.
Immune checkpoint inhibitors (ICI) are associated with a distinct spectrum of toxicities. Data on irAE hospitalization rates and clinical course of patients with thoracic malignancies are lacking.
Patients with advanced thoracic malignancy treated with ICI (2/2016 to 6/2021) were retrospectively identified. Demographic and clinical data of confirmed irAE hospitalizations were extracted from the medical record and a descriptive analysis was performed.
From February 2016 to June 2021, 1312 patients with thoracic malignancy received ICI (monotherapy, combination with 2nd ICI or other agents) with 102 patients (7.7%) hospitalized for irAEs. Treatment intent was first-line therapy in most patients (N = 50, 49%) with 9% (n = 9) receiving adjuvant ICI (N = 9). Sixty patients (59%) received ICI alone, 32% (N = 33) chemo plus immunotherapy, and 7% (N = 7) dual ICI. The median age on admission was 68 years. The median time between ICI initiation and admission was 64 days (1-935 days). Pneumonitis (32.3%; 33/102) was the most frequent indication for admission followed by gastroenterocolitis (19.6%; 20/102), hepatitis (12.7%; 13/102), myo/pericarditis (9.8%; 10/102), and endocrinopathies (9.8%; 10/102). Multi-organ toxicity occurred in 36% (N = 37) of patients. Overall, 85.2% (87/102) of patients received systemic corticosteroids and 17.6% (18/102) required additional lines of immunosuppression. The median length of hospitalization stay was 7 days (2-28 days) with a 25.5% (n = 26) readmission rate within 60 days and an 11.8% (n = 12) in house mortality rate.
Severe irAE requiring inpatient admission, although infrequent, results in considerable morbidity, mortality, and healthcare utilization. Pneumonitis was the most common irAE requiring inpatient management in our patient population with a significant risk of mortality despite the use of guideline-directed systemic immunosuppression. This study highlights the continued need for collaborative efforts amongst medical specialties for improving the diagnostic and therapeutic management of patients with irAEs.
免疫检查点抑制剂（ICI）与一系列独特的毒性有关。关于胸部恶性肿瘤患者因免疫相关不良事件（irAE）住院的比率和临床过程的数据尚缺乏。
回顾性地确定了接受 ICI（2016 年 2 月至 2021 年 6 月）治疗的晚期胸部恶性肿瘤患者。从病历中提取确认的 irAE 住院的人口统计学和临床数据，并进行描述性分析。
从 2016 年 2 月至 2021 年 6 月，1312 例胸部恶性肿瘤患者接受了 ICI（单药治疗、联合二线 ICI 或其他药物）治疗，其中 102 例（7.7%）因 irAE 住院。大多数患者的治疗目的是一线治疗（N=50，49%），其中 9%（n=9）接受辅助 ICI（n=9）。60 例（59%）患者单独接受 ICI 治疗，32%（N=33）接受化疗加免疫治疗，7%（N=7）接受双重 ICI。入院时的中位年龄为 68 岁。ICI 起始与入院之间的中位时间为 64 天（1-935 天）。肺炎（32.3%；33/102）是最常见的住院指征，其次是胃肠结肠炎（19.6%；20/102）、肝炎（12.7%；13/102）、心肌炎/心包炎（9.8%；10/102）和内分泌疾病（9.8%；10/102）。36%（N=37）的患者发生多器官毒性。总体而言，85.2%（87/102）的患者接受了全身皮质类固醇治疗，17.6%（18/102）需要额外的免疫抑制治疗。中位住院时间为 7 天（2-28 天），60 天内再入院率为 25.5%（n=26），院内死亡率为 11.8%（n=12）。
尽管不常见，但严重的 irAE 需要住院治疗，会导致相当大的发病率、死亡率和医疗保健利用。肺炎是我们患者人群中最常见的需要住院管理的 irAE，尽管使用了指南指导的全身免疫抑制，但仍有显著的死亡风险。这项研究强调了需要医学专业之间继续合作，以改善 irAE 患者的诊断和治疗管理。
