Prognostic significance of cutaneous immune-related adverse events in patients with melanoma and other cancers on immune checkpoint inhibitors

Thompson, Leah L.; Chang, Michael S.; Polyakov, Nicole J.; Blum, Amy E.; Josephs, Nathaniel; Krasnow, Nira A.; Yoon, Jaewon; Li, Edward B.; Molina, Gabriel E.; Said, Jordan T.; Huang, Kevin; Kuchroo, Juhi R.; Hinton, Andrea N.; Chen, Shuo

doi:10.1016/j.jaad.2021.03.024

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…They were also associated with a longer OS; however, it was not statistically significant. This is in contrast with other studies where in cIRAEs were associated with better survival outcomes with regard to both PFS and OS [ 4 , 20 – 22 ].…”

Section: Discussioncontrasting

confidence: 98%

Characterization and Prognostic Significance of Cutaneous Immune-Related Adverse Events in Indian Patients on Immune Checkpoint Inhibitor Therapy

Duraisamy,

Panicker,

Jose

2023

Dermatol Pract Concept

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Introduction: Cutaneous immune-related adverse-events (cIRAEs), commonly seen in cancer patients receiving immune checkpoint inhibitors (ICI) are reported to be associated with better patient survival; however, they have seldom been studied in Indian population. Recent reports suggest racial differences in IRAEs and also in survival outcomes. Objective: To study the various cIRAEs in Indian patients on ICI therapy and to analyze the association between cIRAEs and patient survival outcomes. Methods: We conducted a retrospective cohort study of 86 cancer patients receiving immunotherapies in a tertiary care hospital in India and studied incidence, nature and grades of cutaneous immune-related adverse events and the association of cIRAEs with the patient survival outcomes. Results: Eighty-six patients were included, of whom 16 patients (18.6%) developed cIRAEs, with pruritus (12.8%) and maculopapular eruption (8.1%) being the most common. Kaplan–Meier plot with log-rank test showed that patients developing any type of cIRAE had longer progression-free survival than those without (p=0.023) and a better objective-response-rate (50% vs 18.5%, p=0.008). Conclusion: Most common cIRAEs in our study were pruritus and maculopapular rash. The incidence of cIRAEs was lower in our Indian cohort compared to that reported in Caucasian cohorts. Development of cutaneous immune-related adverse event in cancer patients on ICI was associated with a longer progression-free-survival and a better objective-response-rate. Thus, cIRAEs may serve as a surrogate marker for better patient outcomes.

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Section: Discussioncontrasting

confidence: 98%

Characterization and Prognostic Significance of Cutaneous Immune-Related Adverse Events in Indian Patients on Immune Checkpoint Inhibitor Therapy

Duraisamy,

Panicker,

Jose

2023

Dermatol Pract Concept

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“…Maculopapular eruptions have been associated with improved overall survival in patients treated with nivolumab and pembrolizumab, with a statistically significant improvement across all grades of rash severity [ 79 ]. Thomson et al reported that specific cutaneous irAEs, such as lichenoid or psoriasiform morphologies, may hold prognostic significance, whereas others, such as papular eruptions and isolated pruritus, were not meaningfully associated with survival outcomes [ 80 ]. Nikolaou et al reported that the presence of guttate psoriasis and psoriasis affecting over 10 percent of BSA were both associated with better response rates to immunotherapy compared to other types of psoriasis and mild symptomatology, respectively.…”

Section: Survival Related To Cutaneous Immune-related Adverse Eventsmentioning

confidence: 99%

Cutaneous Adverse Reactions of Immunotherapy in Patients with Advanced Melanoma

Nikolaou

Tsimpidakis

Stratigos

2023

Cancers

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Immune checkpoint blockers (ICBs) have been widely used during the last decade for the treatment of various tumors, including advanced and metastatic melanoma. While these agents have improved melanoma patients’ survival rates, they have also been associated with various autoimmune toxicities, with the skin being most commonly affected. The severity of cutaneous toxicity can not only negatively affect patients’ quality of life but can also limit the proper treatment of cancer. Thus, the role of the dermatologist is substantial in early detecting and promptly treating these adverse events. Maculopapular rash, psoriasiform, lichenoid dermatoses and bullous pemphigoid are the most frequent cutaneous adverse events that require immediate intervention. Other rare autoimmune toxicities, e.g., sarcoidosis, dermatomyositis or subacute lupus, have also been reported. In this review, we summarize the aspects of ICB-induced cutaneous toxicities in patients with melanoma, emphasizing their management and treatment options in clinical practice.

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“…To date, the development of ICI therapy has emerged as a treatment option in the management of people living with malignancy, resulting in an increasing number of patients receiving ICI therapy; thus, the occurrence of cirAEs is expected to increase. Interestingly, contemporary evidence also suggests that cirAEs may improve the survival of patients treated with ICI therapy ( 17 , 26 , 27 ). Pragmatic trials, along with large proactive pharmacoepidemiology surveillance studies are warranted to fully understand the risk of cirAEs among patients treated with ICI therapy.…”

Section: Implications For Practice and Future Researchmentioning

confidence: 99%

Incidence and factors associated with cutaneous immune-related adverse events to immune check point inhibitors: An ambispective cohort study

et al. 2022

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BackgroundAlthough immune checkpoint inhibitors (ICIs) have become the frontline treatment option for patients with various advanced cancers due to improved survival, they can be associated with a spectrum of cutaneous immune-related adverse events (cirAEs). However, little is known regarding the occurrence and patterns of cirAE-related ICI therapy in patients of different races other than white populations. Therefore, we investigated the incidence and associated factors of cirAEs among cancer patients in northern Thailand.MethodsA referral-center-based ambispective cohort study was conducted from January 1, 2017, to March 31, 2021. Based on a linked database and merged patient-level data, adult patients with pathologically confirmed cancer who were diagnosed and received ICI therapy regardless of cancer type and followed up through August 31, 2021, were included. All cirAE-related ICI therapy was based on clinical evaluation and ascertainment by a board-certified dermatologist. The incidence of cirAE-related ICI therapy with confidence intervals (CIs) across cancer- and ICI therapy-specific groups was estimated. Factors associated with cirAEs were evaluated using multivariable modified Poisson regression to estimate risk ratios (RRs) and 95% CIs.ResultsThe study included 112 patients (67 men [59.8%]; mean age, 65.0 [range, 31.0-88.0] years), who were mainly diagnosed with lung cancer (56.3%), followed by liver cancer (19.6%). The overall incidence of cirAE-related ICI therapy was 32.1% (95% CI, 24.1-41.4); however, there was no substantial difference in sex, cancer type, or individual ICI therapy. The two identified prognostic risk factors of cirAE-related ICI therapy were age >75 years (adjusted RR, 2.13; 95% CI, 1.09-4.15; P=0.027) and pre-existing chronic kidney disease stages 3-4 (adjusted RR, 3.52; 95% CI, 2.33-5.31; P<0.001).ConclusionsThe incidence of cirAE-related ICI therapy among Thai cancer patients was comparable to that in white populations. Early identification, particularly in elderly patients and those with CKD, should be implemented in clinical practice to help optimize therapeutic decision-making and patient health outcomes.

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Prognostic significance of cutaneous immune-related adverse events in patients with melanoma and other cancers on immune checkpoint inhibitors

Cited by 8 publications

References 5 publications

Characterization and Prognostic Significance of Cutaneous Immune-Related Adverse Events in Indian Patients on Immune Checkpoint Inhibitor Therapy

Characterization and Prognostic Significance of Cutaneous Immune-Related Adverse Events in Indian Patients on Immune Checkpoint Inhibitor Therapy

Cutaneous Adverse Reactions of Immunotherapy in Patients with Advanced Melanoma

Incidence and factors associated with cutaneous immune-related adverse events to immune check point inhibitors: An ambispective cohort study

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