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Vol. 62. Issue 2.
Pages 131-138 (March - April 2020)
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Vol. 62. Issue 2.
Pages 131-138 (March - April 2020)
Original articles
DOI: 10.1016/j.rxeng.2019.10.006
Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy
Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia
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A. Ezponda Casajúsa,
Corresponding author
aezponda@unav.es

Corresponding author.
, M. Calvo Imirizaldua, J.P. de Torres Tajesb, A. García-Baizána, E. Castañón Álvarezc, D. Cano Rafarta, I. Vivas Péreza, G. Bastarrika Alemaña
a Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
c Departamento de Oncología Médica, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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Tables (5)
Table 1. Some of the drugs approved by the United States Food and Drug Administration included in the study, with their indications for the tumours included in this publication.
Table 2. Response criteria for immunotherapy.
Table 3. Number of patients with immune-related adverse events in the different tumour groups, depending on the histological type. Those that are accompanied by radiological expression are detailed.
Table 4. Number of immune-related adverse events observed in all the groups of patients by response.
Table 5. Patients from all the tumour groups who had immune-related adverse events, categorised into two immunotherapy response groups.
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Abstract
Objective

To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy.

Material and methods

We retrospectively included 79 patients with stage IV lung carcinomas (n = 24), renal carcinomas (n = 11), or melanoma (n = 44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern.

Results

Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p = 0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p = 0.023).

Conclusions

The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.

Keywords:
Immunotherapy (MeSH term)
Immune-related response criteria
Immune-related adverse reactions
Medical oncology (MeSH term)
Resumen
Objetivo

Identificar la incidencia de reacciones adversas inmunomediadas (irAE, immune related adverse events), con y sin manifestaciones radiológicas, y correlacionarla con la respuesta al tratamiento inmunoterápico.

Material y métodos

Se reclutaron retrospectivamente 79 pacientes con carcinomas de pulmón (n = 24), renal (n = 11) y melanoma (n = 44) en estadio IV que fueron tratados con fármacos inmunoterápicos. Se valoró la aparición de irAE, sus manifestaciones radiológicas y el tipo de patrón de respuesta de acuerdo con los criterios de respuesta a la inmunoterapia (irRC). Se relacionó la presencia de irAE con el patrón de respuesta al tratamiento.

Resultados

El 27,8% de los pacientes sufrieron irAE. Estas reacciones fueron más frecuentes en pacientes con melanoma (40,9% de los pacientes). Más de la mitad de las reacciones (59,1%) presentaron manifestaciones radiológicas a modo de neumonitis, colitis, hipofisitis, tiroiditis y miocarditis. La neumonitis fue la irAE con expresión radiológica más frecuente, incluso en pacientes asintomáticos. En la población estudiada, la tasa de respuesta a la inmunoterapia fue significativamente mejor en pacientes que desarrollaron irAE (68,2% frente a 38,6%, χ2 = 5,58; p =  0,018). La tasa de respuesta favorable en los pacientes con y sin manifestaciones radiológicas de las irAE fue de 84,6% y 44,4%, respectivamente (p =  0,023).

Conclusiones

La presencia de reacciones adversas inmunomediadas se asocia, de forma significativa, con una mejor respuesta a la inmunoterapia. La asociación con respuesta favorable es incluso mayor en pacientes con manifestaciones radiológicas de las irAE.

Palabras clave:
Inmunoterapia
Criterios de respuesta
Reacciones adversas inmunomediadas
Oncología

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