Treatment patterns and survival outcomes of patients admitted to the intensive care unit due to immune‐related adverse events of immune checkpoint inhibitors

• Published in: Cancer medicine (Malden, MA) Vol. 13; no. 12; pp. e7302 - n/a
• Main Authors: Lin, Lishi, Houwink, Aletta P. I., van Dieren, Jolanda M., Wolthuis, Esther K., van Thienen, Johannes V., van der Heijden, Michiel S., Haanen, John B. A. G., Beijnen, Jos H., Huitema, Alwin D. R.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2024; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Adverse events; Aged; Aged, 80 and over; Apheresis; Biopsy; Cancer; CTLA-4 Antigen - antagonists & inhibitors; CTLA-4 protein; Diabetes; Diabetes mellitus; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - mortality; Female; Heart diseases; Hospitals; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; immune‐related adverse events; Incidence; Intensive care; intensive care unit; Intensive Care Units - statistics & numerical data; Ketoacidosis; Male; Medical prognosis; Melanoma; Mesothelioma; Middle Aged; Myelitis; Myocarditis; Myositis; Neoplasms - drug therapy; Neoplasms - mortality; Nephritis; Oncology; Patients; PD-1 protein; Pneumonitis; Population studies; Renal replacement therapy; Retrospective Studies; Standard of care; Steroids; Survival; Toxicity; Ventilators; United States > US; Netherlands; immune‐related adverse events; intensive care unit; immune checkpoint inhibitors; survival
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.7302

Introduction Severe immune‐related adverse events (irAEs) due to immune checkpoint inhibitors (ICIs) can lead to admission to the intensive care unit (ICU). In this retrospective study, we determined the incidence, treatment patterns and survival outcomes of this patient population at a comprehensive cancer center. Methods All patients admitted to the ICU due to irAEs from ICI treatment between January 2015 and July 2022 were included. Descriptive statistics were reported on patient characteristics and treatment patterns during hospital admission. Overall survival (OS) from the time of ICU discharge to death was estimated using the Kaplan–Meier method. Results Over the study period, 5561 patients received at least one ICI administration, of which 32 patients (0.6%) were admitted to the ICU due to irAEs. Twenty patients were treated with anti‐PD‐1 plus anti‐CTLA‐4 treatment, whereas 12 patients were treated with ICI monotherapy. The type of irAEs were de novo diabetes‐related ketoacidosis (n = 8), immune‐related gastrointestinal toxicity (n = 8), myocarditis or myositis (n = 10), nephritis (n = 3), pneumonitis (n = 2), and myelitis (n = 1). The median duration of ICU admission was 3 days (interquartile range: 2–6 days). Three patients died during ICU admission. The median OS of the patients who were discharged from the ICU was 18 months (95% confidence interval, 5.0—NA). Conclusion The incidence of irAEs leading to ICU admission in patients treated with ICI was low in this study. ICU mortality due to irAEs was low and a subset of this patient population even had long‐term survival.