Wiegmann Jonas Paul, Fröhlich Tabea, Möhn Nora, Duzzi Laura, Narten Emily, Aurich Johanna, Thomas Janin, Grote-Levi Lea, Mahjoub Susann, Berliner Dominik, Wirth Thomas, Golpon Heiko, Bollmann Benjamin-Alexander, Von Wasilewski Imke, Gutzmer Ralf, Heidel Florian H, Skripuletz Thomas, Beutel Gernot, Ivanyi Philipp
Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
ICOG-CCCH (Immune Cooperative Oncology Group, Comprehensive Cancer Center Hannover), Hannover, Germany.
Cancer Med. 2025 Feb;14(3):e70582. doi: 10.1002/cam4.70582.
Immune checkpoint inhibitors (ICI) have improved the therapeutic arsenal in outpatient oncology care; however, data on necessity of hospitalizations associated with immune-related adverse events (irAEs) are scarce. Here, we characterized hospitalizations of patients undergoing ICI, from the prospective cohort study of the immune cooperative oncology group (ICOG) Hannover.
Between 12/2019 and 06/2022, 237 patients were included. Clinical data and characteristics of ICI were collected during a 6-month observation period after the initiation of therapy. Descriptive statistics and Kaplan-Meier statistics were administered.
During the observation period, 30/237 patients were hospitalized (HA(+)). Most common underlying tumor entities were malignant melanoma (59.5%), renal cell carcinoma (13.1%), and nonsmall-cell lung carcinoma (12.7%). HA(+) patients exhibited an increased rate of pulmonary and cerebral metastases. We observed a significantly higher hospitalization rate during dual ICI with Nivolumab and Ipilimumab (p = 0.001). The predominant irAEs for hospitalization were colitis (26.7%), followed by hypophysitis (13.3%), leading to a median hospitalization of 7 (1-34) days. Interdisciplinary consultations were frequent, especially to gastroenterology (46.7%) and neurology (26.7%). Although a trend toward a prolonged overall survival in the HA(+) subgroup was identified, no statistically significant differences were found.
The hospitalization rate of 12.6% is comparable to rates reported in previous studies. There was a disproportionate admission of patients with immune-related colitis and hypophysitis compared to the prevalence described under ICI. We observed a high need for interdisciplinary consultations in line with the heterogeneity of immune-mediated side effects. Compared to non-hospitalized patients, there was no survival disadvantage in the HA(+) cohort.
With a relatively low hospitalization rate, short length of stay, and good clinical outcome, our data support the outpatient nature of ICI. The findings underscore the importance of interdisciplinary collaboration and vigilant monitoring of irAEs to ensure timely recognition and management.
免疫检查点抑制剂（ICI）改善了门诊肿瘤护理的治疗手段；然而，与免疫相关不良事件（irAE）相关的住院必要性数据却很稀少。在此，我们根据汉诺威免疫肿瘤协作组（ICOG）的前瞻性队列研究，对接受ICI治疗的患者的住院情况进行了描述。
在2019年12月至2022年6月期间，纳入了237例患者。在治疗开始后的6个月观察期内收集了ICI的临床数据和特征。进行了描述性统计和Kaplan-Meier统计。
在观察期内，237例患者中有30例住院（HA(+)）。最常见的潜在肿瘤类型为恶性黑色素瘤（59.5%）、肾细胞癌（13.1%）和非小细胞肺癌（12.7%）。HA(+)患者出现肺转移和脑转移的发生率增加。我们观察到在使用纳武单抗和伊匹单抗的双联ICI治疗期间，住院率显著更高（p = 0.001）。导致住院的主要irAE为结肠炎（26.7%），其次是垂体炎（13.3%），中位住院时间为7（1 - 34）天。多学科会诊很频繁，尤其是胃肠病学（46.7%）和神经学（26.7%）。尽管在HA(+)亚组中发现了总体生存期延长的趋势，但未发现统计学上的显著差异。
12.6%的住院率与先前研究报道的率相当。与ICI治疗下描述的患病率相比，免疫相关结肠炎和垂体炎患者的入院比例过高。鉴于免疫介导的副作用的异质性，我们观察到对多学科会诊的高度需求。与未住院患者相比，HA(+)队列中没有生存劣势。
我们的数据显示住院率相对较低、住院时间短且临床结果良好，支持ICI的门诊治疗性质。这些发现强调了多学科协作以及对irAE进行密切监测以确保及时识别和管理的重要性。
