Adverse Events From Immune Checkpoint Inhibitors Prolong Hospitalizations, Increase Readmissions
In recent years, there has been a significant increase in hospitalizations, readmissions, and deaths due to immune-related adverse events from immune checkpoint inhibitors, according to a presentation at the ASCO-SITC Clinical Immuno-Oncology Symposium (January 25-27, 2018; San Francisco, CA).
Alterations to the immune system with immune checkpoint inhibitors may result in a variety of immune-related adverse events. These toxicities have been reported extensively in clinical trials, but the impact and magnitude of immune-related adverse events in the real-world—especially in the inpatient setting—remains unclear.
A group of researchers from Massachusetts General Hospital Cancer Center collected data on patients with advanced malignancies who experienced a suspected immune-related adverse event needing admission to an academic hospital from 2011 to 2017. Individual cases were reviewed comprehensively by at least two reviewers, including one sub-specialist. Researchers also surveyed oncologists at Massachusetts General Hospital Cancer Center regarding their confidence managing patients with immune-related adverse events.
Researchers reported 343 hospitalizations for suspected immune-related adverse events over the 6-year span. A majority of these (65%; n = 223) were confirmed immune-related adverse events that required treatment with immunosuppression or therapy stopped as a result. The mean length of stay was 6.3 days (range, 1-31 days), the readmission rate for another immune-related adverse event was 25%, the total readmission rate was 61.7%, and the inpatient mortality rate was 8%.
The most common immune-related adverse events were enterocolitis, pulmonary, hepatic, neurological, endocrinopathies, rheumatologic, dermatologic, cardiovascular, renal, and allergy. A significant increase in readmissions due to immune-related adverse events was identified over the span of the study (P < .01).
Additionally, survey respondents (n = 26) admitted to not feeling comfortable managing immune-related adverse events, and 48% felt that immune-related adverse event complications should be managed on a different service.
Findings from the study led researchers to conclude that there is a critical need for coordinated multidisciplinary approach, comprehensive provider education, and a translational research program for the early detection and intervention of immune-related adverse events.—Zachary Bessette