Abstract
Immunotherapy blocks immunoinhibitory pathways and allows for reversal of immunosuppression caused by malignant tumors. Immunotherapy can cause immune-related adverse events (IrAE) including rash, pneumonitis, colitis endocrinopathy, nephritis, adrenal insufficiency, hepatitis, and uveitis. Limited data exist to predict which patients will have the greatest response to therapy and if there is a correlation between IrAE and immunotherapy effectiveness. The aim of this study was to determine the relationship between IrAE and immunotherapy efficacy. A retrospective medical records review was collected of patients with metastatic cancer who received immunotherapy. Data included demographics, Eastern Cooperative Oncology Group Performance Status, imaging, time on treatment, best response, disease progression, and presence or absence of IrAE while on treatment. Treatment response was analyzed using the Response Evaluation Criteria in Solid Tumors guideline, version 1.1. Overall survival probabilities were calculated by the Kaplan-Meier survival method. 456 patients were included for analysis, 175 (38.4%) had an IrAE while on immunotherapy. The development of IrAE correlated with response rate for complete response, partial response, and overall response rate. A significant increase in overall survival was also seen. The presence of IrAE may be a potential predictive indicator for treatment response to immune checkpoint inhibitors.
Highlights
Program death-ligand 1 (PD-L1) inhibitors have been developed to promote the activation of antineoplastic T cells and reduce tumor size [1]
The aim of this study was to determine the relationship between immune-related adverse events (IrAE) and immunotherapy efficacy
Patients who were lost to follow-up and patients who did not receive imaging during their time on immunotherapy and were unable to have Response Evaluation Criteria in Solid Tumors (RECIST) measurements were excluded from the study
Summary
Program death-ligand 1 (PD-L1) inhibitors have been developed to promote the activation of antineoplastic T cells and reduce tumor size [1]. Inhibitors of PD-L1 allow for tumor-invading cells to be recognized and destroyed by cytotoxic T cells and prevent tumor autophagy, stopping malignant cells from adaptation and development [2, 3]. PD-1/PD-L1 inhibitor therapy includes nivolumab, pembrolizumab, atezolizumab, avelumab, and durvalumab. These drugs have been shown to improve outcomes in certain tumor subsets, especially those that harbor a high tumor mutational burden [1]. In one study by Hellmann et al [2] the efficacy of nivolumab ± ipilimumab in the treatment of non-small cell lung cancer (NSCLC) was enhanced in patients with a high tumor mutational burden compared to patients with less mutations [2]. Immunotherapy has been approved for more than 10 different solid tumor types and for any tumor with high
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