Cutaneous immune-related adverse events are associated with longer overall survival in advanced cancer patients on immune checkpoint inhibitors: A multi-institutional cohort study

Abstract

Cutaneous immune-related adverse events (cirAEs) occur in up to 40% of immune checkpoint inhibitor (ICI) recipients. However, the association of cirAEs with survival remains unclear. To investigate the association of cirAEs with survival among ICI recipients. ICI recipients were identified from the Mass General Brigham healthcare system and Dana-Farber Cancer Institute. Patient charts were reviewed for cirAE development within 2years after ICI initiation. Multivariate time-varying Cox proportional hazards models, adjusted for age, sex, race/ethnicity, Charlson Comorbidity Index, ICI type, cancer type, and year of ICI initiation were utilized to investigate the impact of cirAE development on overall survival. Of the 3731 ICI recipients, 18.1% developed a cirAE. Six-month landmark analysis and time-varying Cox proportional hazards models demonstrated that patients who developed cirAEs were associated with decreased mortality (hazardratio [HR]=0.87, P=.027), particularly in patients with melanoma (HR=0.67, P=.003). Among individual morphologies, lichenoid eruption (HR=0.51, P<.001), psoriasiform eruption (HR=0.52, P=.005), vitiligo (HR=0.29, P=.007), isolated pruritus without visible manifestation of rash (HR=0.71, P=.007), acneiform eruption (HR=0.34, P=.025), and non-specific rash (HR=0.68, P<.001) were significantly associated with better survival after multiple comparisons adjustment. Retrospective design; single geography. CirAE development is associated with improved survival among ICI recipients, especially patients with melanoma.