Abstract
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.
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.
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).
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.
