Research and Scholarship

An Evaluation of the Use of Corticosteroids for the Management of Immune-Mediated Adverse Events in Cancer Patients Treated With Immune Checkpoint Inhibitors

Adrian Tsui,(1) PharmD, Lindsay Edmondson,(2) PharmD, BCOP, Justin Julius,(3) PharmD

From (1)Ascension St. John Hospital, Detroit, Michigan; (2) Oregon Health and Science University Hospital, Portland, Oregon; (3)Allegheny Health Network, Kittanning, Pennsylvania

Authors’ disclosures of conflicts of interest are found at the end of this article.

Correspondence to: Adrian Tsui, PharmD, 22101 Moross Road, Detroit, MI 48236. E-mail: adrian.tsui@ascension.org


J Adv Pract Oncol 2021;12(2):137–145 | https://doi.org/10.6004/jadpro.2021.12.2.2 | © 2021 Harborside™


  

ABSTRACT

Immune checkpoint inhibitors (ICIs) have gained prominence for the treatment of a variety of malignancies. However, they are associated with the development of immune-mediated adverse events (IMAEs). Appropriate management of IMAEs and subsequent rechallenging of patients with ICI therapy remains an important area of research. The primary endpoint of this study was to evaluate the efficacy of current prescribing practices and adherence to guideline recommendations for IMAE management. The incidence of symptom resolution, number of patients reinitiated with ICI therapy, and IMAE recurrence upon ICI therapy reinitiation were explored as secondary endpoints. A retrospective chart review within the Allegheny Health Network was conducted in cancer patients treated with ICI therapy who developed a documented ICI-associated IMAE and subsequently received corticosteroid therapy. IRB approval was obtained for this study. Descriptive statistics were used to analyze both primary and secondary endpoints. The study sample was made up of 81 patients. Overall, 50 out of 81 patient cases (62%) were found to be discordant with guideline recommendations; the primary factors identified were inappropriate starting corticosteroid dosing (64%), initiation of a corticosteroid taper prior to IMAE resolution to at least grade 1 severity, and condensed corticosteroid taper (74%). The main IMAEs identified were colitis (28%), pneumonitis (27%), and skin-related inflammation (12%). 76 out of the 81 patients (94%) achieved IMAE resolution; 41 patients (54%) were rechallenged with ICI therapy, of which 14 patients (34%) developed IMAE recurrence. Future studies may focus on evaluating different immunosuppression strategies to optimize IMAE management.




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