Immune-Related Adverse Events and Survival Among Patients With Metastatic NSCLC Treated With Immune Checkpoint Inhibitors

• DOI: 10.1001/jamanetworkopen.2023.52302
• Publication Date: 2024-01-18T16:01:00Z
• Authors: Sarah Cook; Vanessa Samuel; Daniel E. Meyers; Igor Stukalin; Ishjot Litt; Randeep Sangha; Don G. Morris; Daniel Y. C. Heng; Aliyah Pabani; Michelle Dean; Vishal Navani
• Keywords: Discontinuation

Importance Immune-related adverse events (irAEs) secondary to immune checkpoint inhibitor (ICI) therapy reportedly improve overall survival (OS) in patients with non–small cell lung cancer (NSCLC). However, studies have been small and the association between irAE severity OS remains poorly defined. Objective To examine irAEs their locally advanced or metastatic NSCLC receiving ICIs. Design, Setting, Participants This retrospective observational cohort study included ICIs March 1, 2014, November 30, 2021, follow-up until 31, 2023. Data analysis was completed April 26, The Alberta Immunotherapy Database, a provincial, multicenter cohort, used capture data from Alberta, Canada. 803 18 years older who received at least 1 cycle of ICI (alone chemotherapy), agnostic treatment line. Exposure Developing an mandating delay discontinuation and/or systematic corticosteroids for management toxic effects (hereinafter referred as clinically meaningful irAEs). Main Outcomes Measures primary outcome according Kaplan-Meier analysis. Clinically were identified. Patients poor prognosis (survival <3 months) may died prior development excluded analysis, mitigating immortal time bias. Adjusted Cox proportional hazards regression analyses ascertained variables associated OS. Results Among median age 69.7 (IQR, 63.1-75.2) those without 67.5 60.4-73.3) years, comparable sex distribution (139 295 men [47.1%] 156 women [52.9%] vs 254 505 [50.3%] 251 [49.7%] Mitigating bias (n = 611), (median irAEs, 23.7 [95% CI, 19.3-29.1] months; 9.8 8.7-11.4] P < .001). No difference hospital outpatients OS, 20.8 11.7-30.6] 25.6 20.1-29.8] .33). remained total after known prognostic characteristics (hazard ratio, 0.53 0.40-0.70]; Conclusions Relevance In this ICIs, developing improved not compromised by hospitalization severe effects. Whether how resumption is warrants further study.