215 Cutaneous immune-related adverse events predict longer patient survival in advanced cancer patients

Abstract

Cutaneous immune-related adverse events (cirAEs) are the most common toxicities to occur in the setting of immune checkpoint inhibitor (ICI) therapy. However, their impact on mortality is largely understudied. Here, we investigate the impact of cirAEs on survival among ICI recipients using a robust multi-institutional clinical registry. 3,731 ICI recipients were identified from the Mass General Brigham Healthcare System and the Dana-Farber Cancer Institute, of which 676 developed cirAEs and 3,055 did not. Landmark survival analyses and time-varying Cox proportional hazards modeling were performed, adjusting for demographics, Charlson comorbidity index, cancer type, ICI target, and year of ICI initiation. Overall, patients who developed cirAEs were significantly protected from mortality (HR=0.87, p=0.036), particularly in the setting of melanoma (HR=0.67, p=0.007). Among individual morphologies, lichenoid eruption (HR=0.46, p<0.001), psoriasiform eruption (HR=0.43, p=0.004), vitiligo (HR=0.26, p=0.012), and non-specific rash (HR=0.69, p<0.001) were significantly protective of mortality after multiple comparisons adjustment. Our results demonstrate that CirAE development is associated with a 13% reduction in mortality among all cancers and a 33% reduction in melanoma patients. Furthermore, almost all cirAE morphologies are associated with better survival. Even after excluding vitiligo, cirAE development remains protective among all ICI recipients and melanoma patients. These findings are important as cirAEs tend to occur early after ICI initiation and may serve as predictive biomarkers of therapeutic response.