Zhang S, Tang K, Wan G, Nguyen N, Lu C, Ugwu-Dike P, Raval N, Seo J, Alexander NA, Jairath R, Phillipps J, Leung BW, Roster K, Chen W, Zubiri L, Boland G, Chen ST, Tsao H, Demehri S, LeBoeuf NR, Reynolds KL, Yu KH, Gusev A, Kwatra SG, Semenov YR. Cutaneous immune-related adverse events are associated with longer overall survival in advanced cancer patients on immune checkpoint inhibitors: a multi-institutional cohort study.
medRxiv 2023:2023.01.16.23284635. [PMID:
36711758 PMCID:
PMC9882466 DOI:
10.1101/2023.01.16.23284635]
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Abstract
Background
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.
Objective
To investigate the association of cirAEs with survival among ICI recipients.
Methods
ICI recipients were identified from the Mass General Brigham healthcare system (MGB) and Dana-Farber Cancer Institute (DFCI). Patient charts were reviewed for cirAE development within 2 years 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.
Results
Of the 3,731 ICI recipients, 18.1% developed a cirAE. 6-month landmark analysis and time-varying Cox proportional hazards models demonstrated that patients who developed cirAEs were associated with decreased mortality (HR=0.87,p=0.027), particularly in melanoma patients (HR=0.67,p=0.003). Among individual morphologies, lichenoid eruption (HR=0.51,p<0.001), psoriasiform eruption (HR=0.52,p=0.005), vitiligo (HR=0.29,p=0.007), isolated pruritus without visible manifestation of rash (HR=0.71,p=0.007), acneiform eruption (HR =0.34,p=0.025), and non-specific rash (HR=0.68, p<0.001) were significantly associated with better survival after multiple comparisons adjustment.
Limitations
Retrospective design; single geography.
Conclusion
CirAE development is associated with improved survival among ICI recipients, especially melanoma patients.
Capsule Summary
Patients on immune checkpoint inhibitors (ICIs) who developed cutaneous immune-related adverse events (cirAEs) had favorable outcomes. This was especially notable for melanoma patients who had cirAEs, both those with vitiligo and other morphologies.Development of cirAEs in ICI-treated patients can be used to prognosticate survival and guide treatment decisions.
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