Aim: This cohort study evaluated the association between immune checkpoint inhibitors (ICIs)-induced immune-related adverse events (irAEs) and mortality as well as ICI discontinuation among older adults with NSCLC.Methods: 2007-2019 Surveillance, Epidemiology and End Results-Medicare linked database was used and survival analysis with time-varying exposure of irAEs was applied to estimate the associations.Results & conclusion: A total of 8,175 individuals were included, with 46.8% of whom developed an irAE. Cox regression models showed the occurrence of any irAEs was associated with increased risk of mortality (HR: 1.73, 95% CI: 1.63-1.82) and treatment discontinuation (HR: 1.87, 95% CI: 1.78-1.97). Some variability was observed in the effect on the two outcomes depending on the type of irAE.
Keywords: immune checkpoint inhibitors; immune-related adverse events; non-small-cell lung cancer; older adults; survival.
A few studies have suggested that certain adverse events related to the immune system (called immune-related adverse events, or irAEs) following treatment of immune checkpoint inhibitors (ICIs) are linked to better clinical outcomes associated with ICI treatment. In contrast, this study of older adults with lung cancer found that patients suffering from irAEs were more likely to die and discontinue ICI treatment. Adverse events such as pneumonitis, arrhythmia, acute kidney injury, hepatitis and colitis were found to be associated with worse outcomes, while hypothyroidism and dermatologic irAEs were not. To prevent life-threatening outcomes for older adults with lung cancer, it is important to closely monitor for the development of irAEs following the initiation of ICI therapy.