Infectious complications of immune checkpoint inhibitors in solid organ malignancies

Ross, Justine Abella; Komoda, Kellie; Pal, Sumanta K.; Dickter, Jana; Salgia, Ravi; Dadwal, Sanjeet

doi:10.1002/cam4.4393

Cited by 21 publications

(17 citation statements)

References 9 publications

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“…9,23 Noteworthy, in the sensitivity analysis of patients who were treated with ICIs as a second line, those who experienced neutropenia or infections during previous CC were more likely to develop infections during ICIs compared to those who received CC alone, which did not influence the risk of infections during ICIs. Similarly, Ross and colleagues did not observe any association between previous chemotherapy and infection during treatment with ICIs 24 ; however, in this paper only patients affected by severe infections requiring hospitalization were considered, while, in our cohort, the majority of infectious episodes were managed as outpatients. In addition, in this population, the additional risk caused by irAEs and prolonged steroid therapy has been confirmed.…”

Section: Univariate Analysismentioning

confidence: 38%

“…In patients who had at least one infection, irAEs (72% vs 49%, P = .006) and prolonged steroid therapy for their management (73% vs 31%, P < .001) were more frequently observed. The median (q1-q3) time to irAEs since the start of therapy was 9 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) weeks in patients without infections, as compared to 13 (3-31) weeks in subjects with at least one infection (P = .064).…”

Section: General Characteristics Of the Study Populationmentioning

confidence: 98%

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Incidence and predictors of infections in patients with advanced non‐small cell lung cancer treated with checkpoint inhibitor immunotherapies: A monocentric retrospective cohort study

Bavaro,

Diella,

Pizzutilo

et al. 2023

Scand J Immunol

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Immune checkpoint inhibitors (ICIs) represent the cornerstone of the current treatment of non‐small cell lung cancer (NSCLC). However, the occurrence of concomitant infections might hamper success. All consecutive patients with advanced NSCLC who started ICIs as a first‐ or second‐line therapy from January 1, 2017 to June 30, 2020 were retrospectively evaluated. The occurrence of infectious events during ICIs was correlated with clinical characteristics, including previous Cytotoxic Chemotherapy (CC), occurrence of immune‐related‐adverse‐events (irAEs). A total of 211 patients were included, 46 (22%) females, with a median (q1‐q3) age of 69 (62‐76) years. Overall, 85 patients (40%) received ICIs as a first treatment line and 126 (60%) as a second line; 40 patients (19%) had at least one infection during ICIs, and 17 (8%) more than one. Notably, autoimmune diseases (P < .005), neutropenia (P = .001) or infections during previous CC (P = .001), irAEs (P = .006), or steroid therapy for irAEs (P < .001) were associated with infection development. By multivariate Cox‐regression, autoimmune diseases (aHR = 6.27; 95%CI = 2.38‐16.48; P < .001) and steroid therapy for irAEs (aHR = 2.65; 95%CI = 1.27‐5.52; P < .009) were associated with a higher risk of infection during ICIs. Interestingly, autoimmune diseases were confirmed as risk factors in patients treated with ICIs as a first line, while previous infections were the only independent predictor of infections in patients treated with ICIs as a second line. Patients with NSCLC treated with ICIs with concurrent autoimmune disease, receiving steroid therapy for management of irAEs, or having a history of previous infections during CC should be actively monitored for the risk of developing infectious complications.

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Section: Univariate Analysismentioning

confidence: 38%

Section: General Characteristics Of the Study Populationmentioning

confidence: 98%

Incidence and predictors of infections in patients with advanced non‐small cell lung cancer treated with checkpoint inhibitor immunotherapies: A monocentric retrospective cohort study

Bavaro,

Diella,

Pizzutilo

et al. 2023

Scand J Immunol

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“…Among patients taking anti-CTL4 agents, 70% develop adverse events, 20% of which are severe [ 35 ]. In addition, 30% of patients treated with anti-CTLA-4 develop an infectious complication [ 36 ]. In patients treated with anti-PD-1 or anti-PD-L1, 80% develop adverse events, 8% of which are severe [ 35 ].…”

Section: Monoclonals Antibodiesmentioning

confidence: 99%

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Pilmis

Kherabi

Huriez

et al. 2023

Cancers

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Background: Infections are well known complications of some targeted drugs used to treat solid organ cancer and hematological malignancies. Furthermore, Individual patient risk factors are associated with underlying pathologies, concomitant immunosuppressive treatment, prior treatment and use of anti-infective prophylaxis. Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Objectives: In this narrative review, we present the current state of knowledge concerning the infectious complications occurring in patients treated with immune checkpoint inhibitors (ICIs), Bruton’s tyrosine kinase (BTK) inhibitors, phosphatidylinositol 3-kinase (PI3K) inhibitors, antiapoptotic protein BCL-2 inhibitors, Janus kinase inhibitors or CAR-T cell infusion. Sources: We searched for studies treating infectious complications of ICIs, BTK inhibitors, PI3K inhibitors, antiapoptotic protein BCL-2 inhibitors and CAR-T cell therapy. We included randomized, observational studies and case reports. Content: Immune-related adverse events (irAEs) are frequent among patients treated with new targeted drugs. Treatment of irAEs with corticosteroids and other immunosuppressive agents can lead to opportunistic infections. Bruton’s tyrosine kinase (BTK) inhibitors are associated with higher rate of infections, including invasive fungal infections. Implications: Infections, particularly fungal ones, are common in patients treated with BTK inhibitors even though most of the complications occurring among patients treated by ICIs or CART-cells infusion are associated with the treatment of side effects related to the use of these new treatments. The diagnosis of these infectious complications can be difficult and may require extensive investigations.

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“…En una revisión publicada por J. A. Ross et al 6 se describe que la tasa de infección es del 18% al 19% en los tratados con inhibidores del Check point, donde el uso de corticoides no se asoció con un mayor riesgo de infección. En el 24% de los pacientes se sospechaba la presencia de infección bacteriana, con un 8% de cultivos bacterianos confirmados.…”

Section: Discusión Clínicaunclassified

Tos y fiebre en paciente oncológica, ¿cuál es su diagnóstico?

Gatica

Pitrella²,

Villalobos³

2022

Rev Am Med Resp

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Infectious complications of immune checkpoint inhibitors in solid organ malignancies

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 21 publications

References 9 publications

Incidence and predictors of infections in patients with advanced non‐small cell lung cancer treated with checkpoint inhibitor immunotherapies: A monocentric retrospective cohort study

Incidence and predictors of infections in patients with advanced non‐small cell lung cancer treated with checkpoint inhibitor immunotherapies: A monocentric retrospective cohort study

Infectious Complications of Targeted Therapies for Solid Cancers or Leukemias/Lymphomas

Tos y fiebre en paciente oncológica, ¿cuál es su diagnóstico?

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