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Immune-related adverse events in patients with solid-organ tumours treated with immunotherapy: a 3-year study of 102 cases from a single centre
I. Gonzalez-Mazón1, L. Sánchez-Bilbao2, J.L. Martín-Varillas3, A. García-Castaño4, M. Delgado-Ruiz5, I. Bernat Piña6, J.L. Hernández7, S. Castañeda8, J. Llorca9, M.A. González-Gay10, R. Blanco11
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Oncology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Oncology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Oncology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Internal Medicine Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
- Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-Roche, EPID-Future, Universidad Autónoma, Madrid, Spain.
- University of Cantabria - IDIVAL, Santander, and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain.
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, and University of Cantabria - IDIVAL, Santander, Spain. miguelaggay@hotmail.com
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. ricardo.blanco@scsalud.es
CER13317
2021 Vol.39, N°3
PI 0612, PF 0620
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PMID: 32896258 [PubMed]
Received: 13/03/2020
Accepted : 01/06/2020
In Press: 03/09/2020
Published: 21/05/2021
Abstract
OBJECTIVES:
Immune checkpoint blockade therapy (ICBT) increases the anti-tumoural function of the immune system, but it can also induce immune-related adverse events (irAEs). Our aim was to assess the irAEs due to ICBT in patients from a single centre of Northern Spain.
METHODS:
We set up an observational study of patients treated in monotherapy with ICBT targeted against cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1) or its ligand (PD-L1) for solid organ tumours. All patients were followed up in a single University Hospital from March 2015 to September 2018.
RESULTS:
We studied 102 patients (63 men/39 women); mean age 60.6±9.7 years, with lung (n=63), melanoma (n=21), kidney (n=11), gastric (n=3), colon (n=3) or bladder (n=1) cancer. Only 7 patients had a previous diagnosis of an immune-mediated disease, specifically: psoriasis (n=2), psoriatic arthritis (n=1), systemic lupus erythematosus (n=1), spondyloarthitis (n=1), rheumatoid arthritis (n=1) and cutaneous lupus (n=1). One of the following ICBT was administered: nivolumab (n=52), pembrolizumab (n=35), atezolizumab (n=10) and ipilimumab (n=5). After a mean follow-up time of 14.4±7.7 months since ICBT onset, 87 (85.3%) patients had experienced irAEs, mostly gastrointestinal, thyroid and musculskeletal manifestations including inflammatory arthralgia (n= 8), arthritis (n= 6) and myositis (n=2). ICBT was discontinued in 41 patients but it was reintroduced in 30 of them after resolution of the adverse event, with a good tolerance in all cases. Thirty-six (41.4%) of the 87 patients required specific treatment (prednisone, levothyroxine, and thiamazol) for the irAEs.
CONCLUSIONS:
irAEs are frequent in patients undergoing ICBT. Almost half of the patients that have irAEs require treatment. Musculoskeletal manifestations are not uncommon.