Immune-Related Adverse Events in Metastatic Kidney Cancer: A Sign of Treatment Success?
Posted: Friday, April 26, 2019
With immunotherapies such as nivolumab in patients treated for metastatic renal cell carcinoma, the presence, versus absence, of adverse events may mean that the treatment is working. As described in the Journal for ImmunoTherapy of Cancer, an analysis of the Italian Renal Cell Cancer Early Access Program, in which patients with previously treated metastatic renal cell carcinoma were able to receive nivolumab prior to regulatory approval, indicated that patients who experienced adverse events ultimately benefited more from nivolumab than those who did not.
Elena Verzoni, MD, of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, and colleagues reported that the appearance of immune-related adverse events strongly correlated with survival benefit (median overall survival not reached vs. 16.8 months; P = .002). Immune-related adverse events—a subcategory of drug-related adverse events—included those of a cutaneous, endocrine, hepatic, gastrointestinal, and pulmonary nature that were likely or certainly related to nivolumab. Although the correlation was not as strongly significant, patients with drug-related adverse events (immune-related and non–immune-related combined) had a longer overall survival than those without these adverse events (median 22.5 vs. 16.4 months; P = .01). However, 22 of the 389 enrolled patients discontinued treatment because of drug-related adverse events.
“Further studies could confirm the potential role of the incidence of immune-related adverse events as a predictor of response to immune checkpoint inhibitors [like nivolumab], as well as explore the underlying mechanisms leading to the development of immune-related toxicity,” wrote Dr. Verzoni and colleagues. All ongoing work should have “the aim to better personalize the treatment management in this disease setting,” they concluded.
Disclosure: The study authors reported no conflicts of interest.