ONCOmmunity

Cutaneous immune-related adverse events are associated with longer overall survival in advanced cancer patients on immune checkpoint inhibitors: A multi-institutional cohort study.

By: Shijia Zhang, Kimberly Tang, Guihong Wan, Nga Nguyen, Chenyue Lu, Pearl Ugwu-Dike, Neel Raval, Jayhyun Seo, Nora A Alexander, Ruple Jairath, Jordan Phillipps, Bonnie W Leung, Kathleen Roster, Wenxin Chen, Leyre Zubiri, Genevieve Boland, Steven T Chen, Hensin Tsao, Shadmehr Demehri, Nicole R LeBoeuf, Kerry L Reynolds, Kun-Hsing Yu, Alexander Gusev, Shawn G Kwatra, Yevgeniy R Semenov

Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.
2022-5-9; doi: 10.1016/j.jaad.2022.12.048

Abstract

Background

Cutaneous immune-related adverse events (cirAEs) occur in up to 40% of immune checkpoint inhibitor (ICI) recipients. However, the association of cirAEs with survival remains unclear.

Objective

To investigate the association of cirAEs with survival among ICI recipients.

Methods

ICI recipients were identified from the Mass General Brigham healthcare system and Dana-Farber Cancer Institute. Patient charts were reviewed for cirAE development within 2 years after ICI initiation. Multivariate time-varying Cox proportional hazards models, adjusted for age, sex, race/ethnicity, Charlson Comorbidity Index, ICI type, cancer type, and year of ICI initiation were utilized to investigate the impact of cirAE development on overall survival.

Results

Of the 3731 ICI recipients, 18.1% developed a cirAE. Six-month landmark analysis and time-varying Cox proportional hazards models demonstrated that patients who developed cirAEs were associated with decreased mortality (hazardratio [HR] = 0.87, P = .027), particularly in patients with melanoma (HR = 0.67, P = .003). Among individual morphologies, lichenoid eruption (HR = 0.51, P < .001), psoriasiform eruption (HR = 0.52, P = .005), vitiligo (HR = 0.29, P = .007), isolated pruritus without visible manifestation of rash (HR = 0.71, P = .007), acneiform eruption (HR = 0.34, P = .025), and non-specific rash (HR = 0.68, P < .001) were significantly associated with better survival after multiple comparisons adjustment.

Limitations

Retrospective design; single geography.

Conclusion

CirAE development is associated with improved survival among ICI recipients, especially patients with melanoma.