ICU admission for solid cancer patients treated with immune checkpoint inhibitors

• DOI: 10.1186/s13613-023-01122-z
• Publication Date: 2023-04-18T17:02:48Z
• Authors: Anne-Claire Toffart; Anne-Pascale Meert; Florent Wallet; Aude Gibelin; Olivier Guisset; Frédéric Gonzalez; Amélie Seguin; Achille Kouatchet; Myriam Delaunay; Didier Debieuvre; Boris Duchemann; Gaëlle Rousseau-B...; Martine Nyunga; David Grimaldi; Albrice Levrat; Elie Azoulay; Virginie Lemiale
• Keywords: Solid tumor; RC86-88.9; Intensive care; Research; Immune-related adverse event; Economie; Medical emergencies. Critical care. Intensive care. First aid; Immune checkpoint inhibitor; 3. Good health

Abstract Background Immune checkpoint inhibitors (ICI) have revolutionized the management of cancer. They can induce immune-related adverse events (irAE) leading to intensive care unit (ICU) admission. We aimed to describe irAEs for ICU admissions in solid cancer patients treated with ICIs.

Methods This prospective multicenter study was conducted in France and Belgium. Adult patients with solid tumor and treated with systemic ICIs within the last 6 months, requiring non-programmed ICU admission were included. Patients admitted for microbiologically documented sepsis were excluded. Imputability of irAEs in ICU admissions was described according to the WHO-UMC classification system at ICU admission and at ICU discharge. The use of immunosuppressant treatment was reported.

Results 115 patients were eligible. Solid tumor was mainly lung cancer (n = 76, 66%) and melanoma (n = 18, 16%). They were mainly treated with an anti-PD-(L)1 alone (n = 110, 96%). Main ICU admission reasons were acute respiratory failure (n = 66, 57%), colitis (n = 14, 13%), and cardiovascular disease (n = 13, 11%). ICU admission was considered “likely” associated with irAE for 48% (n = 55) of patients. Factors independently associated with irAE were a good ECOG performance status (PS) (ECOG-PS of 0 or 1 vs. ECOG-PS of 2–3, odds ratio [OR] = 6.34, 95% confidence interval [95% CI] 2.13–18.90, and OR = 3.66, 95% CI 1.33–10.03, respectively), and a history of irAE (OR = 3.28, 95% CI 1.19–9.01). Steroids were prescribed for 41/55 (75%) patients with ICU admission “likely” related to irAE. Three patients were subsequently treated with immunosuppressants.

Conclusion IrAEs accounted for half of ICU admissions in cancer patients receiving ICIs. They could be treated with steroids. Identifying the imputability of irAEs in ICU admissions remains a challenge.