Long-Term irAEs From Checkpoint Inhibitors Have Considerations for Survivorship

The researchers looked at data (https://jamanetwork.com/journals/jamaoncology/article-abstract/2777580) from 387 patients with melanoma who were treated at eight hospitals in the United States and Australia. All of the patients received standard therapy (i.e., surgery followed by nivolumab or pembrolizumab). Overall, 43% reported experiencing a long-term irAE, with 96% reporting mild symptoms and 4% severe. Of those, 86% said that the irAE did not improve during the study period.

The most common irAEs were skin rash, hypothyroidism, and joint pain. The ones most likely to persist were Addison disease, arthritis or joint pain, eye-related issues (e.g., conjunctivitis, blurred vision), inflammation of the pituitary gland, and thyroiditis or hypothyroidism. About 25% of patients stopped treatment early because of the adverse event.

All of the patients in the trial were receiving the checkpoint inhibitor as adjuvant treatment during remission, and the researchers cited the implications for survivorship. ONS offers additional information on nursing considerations for melanoma survivorship care online (https://voice.ons.org/news-and-views/nursing-considerations-for-melanoma-survivorship-care).

“Chronic irAEs associated with anti–PD-1 therapy appear to be more common than previously recognized and frequently persisted even with prolonged follow-up, although most were low grade,” the researchers concluded (https://jamanetwork.com/journals/jamaoncology/article-abstract/2777580). “The risks of chronic irAEs should be integrated into treatment decision-making.”