Evaluating Survival After Hospitalization Due to Immune-Related Adverse Events From Checkpoint Inhibitors

Jordyn Silverstein; Francis Wright; Michelle Wang; Arabella Young; Daniel Kim; Kimberly De Dios; Sam Brondfield; Zoe Quandt

doi:10.1093/oncolo/oyad135

Evaluating Survival After Hospitalization Due to Immune-Related Adverse Events From Checkpoint Inhibitors

Oncologist. 2023 Oct 3;28(10):e950-e959. doi: 10.1093/oncolo/oyad135.

Authors

Jordyn Silverstein¹, Francis Wright¹, Michelle Wang^{2

3}, Arabella Young^{4

5}, Daniel Kim¹, Kimberly De Dios^{6

7}, Sam Brondfield^{8

9}, Zoe Quandt^{6

7}

Affiliations

¹ Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
² Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
³ Graduate Program in Pharmaceutical Sciences and Pharmacogenomics, University of California, San Francisco, San Francisco, CA, USA.
⁴ Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
⁵ Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
⁶ Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁷ Diabetes Center, University of California, San Francisco, San Francisco, CA, USA.
⁸ Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA.
⁹ Department of Medicine, Division of Hematology and Oncology, University of California, San Francisco, San Francisco, CA, USA.

Abstract

Background: As immune checkpoint inhibitors (CPI) are increasingly approved for cancer treatment, hospitalizations related to severe immune-related adverse events (irAE) will increase. Here, we identify patients hospitalized due to irAEs and describe survival outcomes across irAE, CPI, and cancer type.

Methods: We identified patients hospitalized at our institution from January 2012 to December 2020 due to irAEs. Survival was analyzed using Kaplan-Meier survival curves with log-rank tests.

Results: Of 3137 patients treated with CPIs, 114 (3.6%) were hospitalized for irAEs, resulting in 124 hospitalizations. Gastrointestinal (GI)/hepatic, endocrine, and pulmonary irAEs were the most common causes of irAE-related hospitalization. After CPI initiation, the average time to hospitalization was 141 days. Median survival from hospital admission was 980 days. Patients hospitalized due to GI/hepatic and endocrine irAEs had longer median survival than patients with pulmonary irAEs (795 and 949 days vs. 83 days [P < .001]). Patients with melanoma and renal cell carcinoma had longer median survival than patients with lung cancer (2792 days and not reached vs. 159 days [P < .001]). There was longer median survival in the combination group compared to the PD-(L)1 group (1471 vs. 529 days [P = .04]).

Conclusions: As CPI use increases, irAE-related hospitalizations will as well. These findings suggest that among patients hospitalized for irAEs, survival differs by irAE and cancer type, with worse survival for patients with irAE pneumonitis or lung cancer. This real-world data contributes to research pertaining to hospitalization due to severe irAEs, which may inform patient counseling and treatment decision-making.

Keywords: cancer; hospitalization; immune checkpoint inhibitors; immunotherapy; irAE.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Renal Cell*
Hospitalization
Humans
Kidney Neoplasms* / pathology
Lung Neoplasms*
Melanoma*
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding