Patients with melanoma who are being treated with immune checkpoint inhibitors (ICI) and have cutaneous immune-related adverse events (cIRAEs) are at an increased risk for multisystem immune-related toxicities and should be monitored closely. On the other hand, these patients appear to have an improved chance of survival compared with those without cIRAEs.
Elle Kim, MD, Johns Hopkins University, Maryland, pointed out that cIRAEs are among the earliest toxicities in patients treated with ICIs. “They serve as a signal of immune system activation and have been associated with improved survival,” she wrote. The current study evaluated the association between cIRAEs and the risk for subsequent toxicities among patients with melanoma who are being treated with ICIs. Dr. Kim and colleagues used data from the TrinetX cohort and included 10,552 patients for analysis. Of these 10,552 patients with melanoma, 2,063 had cIRAEs, and 8,489 did not have cIRAEs. Propensity score matching was used to compare 2,063 patients with cIRAEs and 2,063 patients without cIRAEs.
During the 1 year of follow-up, patients with cIRAEs had a significantly increased risk for gastrointestinal toxicities like mucositis and epithelial damage ocular side effects such as orbital and uveal inflammatory disease (HR 2.86), endocrine adverse events, like adrenocortical insufficiency (HR 1.74), and musculoskeletal problems including inflammatory and autoimmune arthritis (HR 1.69). However, patients with cIRAEs also had a significantly reduced risk for death (HR 0.69) compared with their non-cIRAE counterparts.
“These findings indicate that patients with cIRAEs need increased monitoring and physician awareness,” concluded Dr. Kim.
Medical writing support was provided by Robert van den Heuvel.
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