Immune-Related Adverse Events With ICIs Linked to Improved Survival in Metastatic NSCLC
Developing a clinically meaningful immune-related adverse event (irAE) was associated with significantly improved overall survival in patients with locally advanced or metastatic non–small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) therapy, according to a study published online in JAMA Network Open.
“This association was not compromised by hospitalization for management of severe toxic effects,” wrote corresponding author Sarah Cook, MBBS, of the University of Calgary, Calgary, Alberta, Canada, and study coauthors.
Although previous studies have reported improved survival in patients with NSCLC who developed irAEs secondary to ICI therapy, the studies were small, and questions remained about the link between irAE severity and overall survival.
This retrospective observational study focused on a multicenter cohort of 803 adults with NSCLC who received ICIs in Alberta, Canada, between March 1, 2014, and November 30, 2021. Among the patients, 297 experienced clinically meaningful irAEs, which researchers defined as irAEs requiring delay or discontinuation of ICI therapy and/or systematic corticosteroids to manage of toxic effects. The median age of patients with irAEs was 69.7 years, and the median age of patients without irAEs was 67.5 years.
After mitigating for immortal time bias, researchers found a median overall survival of 23.7 months in patients with irAEs compared with 9.8 months in patients without irAEs.
For patients with a clinically meaningful irAE, no overall survival difference was associated with hospital vs outpatient treatment for the irAE. Median overall survival was 20.8 months among patients requiring hospitalization and 25.6 months for those treated as outpatients, according to the study.
Several baseline characteristics were associated with irAE development in the cohort, including age 60 years or older, Eastern Cooperative Oncology Group performance status 0, high expression of programmed cell death ligand 1, absence of bone metastases, derived neutrophil lymphocyte ratio of 3 or less, and levels of hemoglobin, albumin, and lactate dehydrogenase (LDH) within reference range.
“Response to ICI therapy was the only treatment-related characteristic associated with irAE development,” the researchers reported.
Reference
Cook S, Samuel V, Meyers DE, et al. Immune-related adverse events and survival among patients with metastatic NSCLC treated with immune checkpoint inhibitors. JAMA Netw Open. 2024;7(1):e2352302. doi:10.1001/jamanetworkopen.2023.52302
