Highlights
- •Severe irAEs (grade III-IV) occurred earlier than mild irAEs (grade I-II) in this study.
- •The main medical needs in the management of immune-related adverse events (irAEs) involved the lung organ.
- •Rechallenge after previous irAE was assessed as feasible in 65% of cases.
- •Initiation of immunotherapy in patients with autoimmune comorbidity was assessed as feasible in 93% of cases.
- •A multidisciplinary approach could help to better appraise and manage irAEs in real life.
Abstract
Purpose
We investigated the activities of an ImmunoTOX board, an academic, multidisciplinary
group of oncologists and organ specialists that adopts a real-life, case-by-case approach
in the management of patients with immune-related adverse events (irAEs).
Experimental design
The ImmunoTOX assessment board was set up in 2016 at Gustave Roussy in France. It
meets every 2 weeks to discuss the case-by-case management of patients presenting
with irAEs. Here, we describe the ImmunoTOX board's activities between 2016 and 2019.
Results
Over study period, 398 requests (concerning 356 patients) were submitted to the ImmunoTOX
board. Most of the requests concerned the putative causal link between immunotherapy
and the irAE (n = 148, 37%), followed by possible retreatment after temporary withdrawal
because of an adverse event (n = 109, 27%), the clinical management of complex situations
(n = 100, 25%) and the initiation of immunotherapy in patients with pre-existing comorbidities
(n = 41, 10%). The ImmunoTOX board discerned 273 irAEs. The five organ systems most
frequently involved by irAEs were lung (n = 58, 21%), gastrointestinal tract (n = 36,
13%), liver or biliary tract (n = 33, 12%), musculoskeletal system (n = 27, 10%),
and nervous system (n = 23, 8%). The time to occurrence was shorter for severe irAEs
(grade III and VI) than for mild irAEs (grades I and II), with medians of 47 and 91
days, respectively (p = 0.0216).
Conclusion
The main medical needs in the management of irAEs involved the lung organ. Severe
irAEs were expected to occur earlier than mild irAEs. This real-life study can help
to better estimate medical needs and therefore help to assess the management of irAEs.
Keywords
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Article info
Publication history
Published online: March 12, 2020
Accepted:
February 11,
2020
Received:
February 6,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
