BOSTON – Immune checkpoint inhibitors, which strengthen the immune response against tumor cells, have become standard of care for many patients with advanced cancers; however, the medications can often cause side effects, most commonly affecting the skin. A new study led by researchers at Massachusetts General Hospital (MGH) and published in JAMA Dermatology indicates that these side effects may actually be an indicator that the medications are working.
For the study, investigators accessed the TriNetX Diamond network, a database of health records and claims data from more than 200 million U.S. and European patients. The team compared information for 14,016 patients with advanced cancer who were treated with immune checkpoint inhibitors: 7,008 who developed skin-related side effects and 7,008 who did not.
The median study follow-up was 3.2 years and 3,233 (26.1%) of the patients had died during that time. Patients who experienced at least one skin-related adverse event had a 22% decrease in mortality. Interestingly, this protective effect was not the same for all skin-related adverse events and was strongest among patients who developed vitiligo (loss of skin color in blotches), lichen planus (an inflammatory skin condition), itchiness, dryness, and non-specific rashes, ranging from a 30%–50% protection from mortality.
“These data provide oncologists and dermatologists with important prognostic information when counseling immunotherapy recipients on the clinical implications of the skin toxicities,” says senior author Yevgeniy R. Semenov, MD, an investigator in the Department of Dermatology at MGH. “Also, skin toxicities tend to occur early in the course of immunotherapy and present an opportunity to evaluate efficacy soon after initiating treatment. As such, our findings may help identify patients who are more likely to benefit from their current immunotherapy regimen versus those who may need to be considered for a stronger or alternative treatment regimen.”
Additional research is needed to understand the mechanisms behind the relationships between these skin reactions and a patient’s prognosis, and whether interventions used to treat or prevent them may affect survival.
About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of “America’s Best Hospitals.”
Journal
JAMA Dermatology
DOI
10.1001/jamadermatol.2021.5476
Method of Research
Observational study
Subject of Research
People
Article Title
Association of Cutaneous Immune-Related Adverse Events With Increased Survival in Patients Treated With Anti–Programmed Cell Death 1 and Anti–Programmed Cell Death Ligand 1 Therapy
Article Publication Date
12-Jan-2022
COI Statement
Dr Zubiri reported personal fees from Merck outside the submitted work. Dr LeBoeuf reported personal fees from Bayer, Synox, Seattle Genetics, Sanofi, and Silverback Therapeutics outside the submitted work. Dr Asgari reported grants from Pfizer outside the submitted work. Dr Semenov reported personal fees from Castle Biosciences and Incyte Corporation outside the submitted work. No other disclosures were reported.
