Predictors of immunotherapy induced immune-related adverse events

Abstract

Background: Immune-related adverse events (IRAE) represent a challenge, potentially limiting the clinical benefits of immune check point inhibitors therapy (ICI). Aim: To evaluate the prevalence and identified potential predictive factors (PF) of IRAE in clinical practice. Methods: We retrospectively identified thoracic tumors patients (pts) treated with ICI between 2016-2018. The type and severity of IRAE, as well as potential PF were collected. Biserial’s correlation coefficient was applied. Results: 44 pts were included (41 (93%) men, mean age at diagnosis of 65±10 years) who received at least one cycle of ICI. 26 pts (59%) were treated with Nivolumab, 16 pts (36%) with Pembrolizumab and 3 pts with Atezolizumab (1 switched from Nivolumab). 19 pts (43%) had IRAE, 3 pts had multiple IRAE. In most pts (74%), the IRAE were of severity grade 1 or 2. In 47% of pts the toxicity was controlled with supportive care and in 26% pts it was administered corticosteroid. In five (26%) of the pts experiencing IRAE, the ICI agent was permanently discontinue due to toxicity. The IRAE most commonly involved the skin (5pts), thyroid (5 pts) and gastrointestinal system (5 pts). Two pts had infusion reactions to nivolumab. The pts that had IRAE had Body Mass Index (BMI) higher than pts without IRAE (27±6 kg/m² vs 23±4 kg/m², p=0.037). No statistically significant association was observed between history of autoimmune disease or chronic infection, kidney function, specific medications and prevalence of IRAE. Conclusion: The prevalence of IRAE in our sample is similar to the reported in literature. Pts with higher BMI are more likely to experience IRAE. One potential explanation is pharmacokinetic changes induced by overweight.