Real-world surveillance of immune checkpoint inhibitor-induced immune-related adverse events and their impact on survival outcomes

<p>Recent advancements in immune checkpoint inhibitors (ICIs) underscore the importance of effectively managing immune-related adverse events (irAEs). This study aimed to systematically monitor the real-world occurrence of irAEs and assess their prognostic implications, including the influence of subsequent steroid therapy.</p><p>We retrospectively analyzed 1008 cancer patients treated with ICIs between 2014 and 2021, gathering comprehensive irAE data spanning their onset, management, and clinical outcomes. Of these patients, 458 (45.4%) experienced a total of 670 irAEs. Skin toxicity emerged as the most prevalent, followed by pneumonitis, hypothyroidism, hepatitis, adrenal insufficiency, and colitis.</p><p>Univariate Kaplan-Meier analysis showed that patients developing irAEs exhibited significantly prolonged overall survival (OS) compared to those who did not (22.1 months vs. 13.2 months, p < 0.0001). Patients administered steroids at a dosage of <2 mg/kg showed comparable prognoses to those without steroid treatment. However, individuals undergoing steroid pulse therapy, particularly for severe pneumonitis and hepatitis, displayed shorter OS (7.8 months vs. 23.4 months, p = 0.016). Moreover, steroid pulse therapy emerged as an adverse prognostic factor in multivariate analysis (hazard ratio: 2.19, 95% confidence interval: 1.34–2.86, p < 0.001).</p><p>In conclusion, prompt steroid intervention for irAEs does not compromise prognosis and should be promptly initiated to mitigate toxicity. Nevertheless, pulse therapy for severe cases constitutes a negative prognostic indicator, emphasizing the importance of early detection in managing such irAEs.</p>