Long term follow-up of immune-related adverse events in cancer survivors

In this study carried out at a single hospital 217 cancer patients, who had at least 2 years follow-up data after treatment with immune checkpoint inhibitors (PD-1 or PD-L1), were followed-up long term for adverse events and health-related quality of life (HRQoL). There were 44 patients with renal cell carcinoma (RCC) in the study. Other cancers included melanoma (135 patients) and lung cancer (38 patients).

Acute adverse events during treatment occurred in 65% of patients. Most of these were mild-moderate in severity. Chronic immune-related adverse events that continued after treatment was stopped were more common in patients treated with a combination of  ipilimumab plus nivolumab, the most common being an under active thyroid gland (hypothyroidism). Other chronic immune-related adverse events included arthritis, adrenal insufficiency (adrenal glands not producing enough hormones), and neuropathy (nerve damage).

There was no difference in blood pressure, glucose level, or BMI from baseline to 2 years after treatment initiation. Body composition showed increased obesity and skeletal muscle mass after 2 years.

Patient-reported outcomes compared favourably with those from people with cancer and the general population. However, younger patients and patients who needed further treatment had worse HRQoL outcomes.

In summary, this analysis of long-term outcomes in cancer patients treated with immune checkpoint inhibitors indicates favourable HRQoL outcomes and no chronic adverse blood pressure and diabetic events. However, this study shows that chronic immune-related adverse events may be more common that previously thought. It is, therefore, important that patients continue to be followed-up for these adverse events.

Read more in Practice Update here

 

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