Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 24, 2021; 12(2): 103-114
Published online Feb 24, 2021. doi: 10.5306/wjco.v12.i2.103
Racial disparities in immune-related adverse events of immune checkpoint inhibitors and association with survival based on clinical and biochemical responses
Monica Peravali, Cristiane Gomes-Lima, Eshetu Tefera, Mairead Baker, Mamta Sherchan, Saira Farid, Kenneth Burman, Florina Constantinescu, Irina Veytsman
Monica Peravali, Irina Veytsman, Department of Hematology/Oncology, MedStar Washington Hospital Center, Washington, DC 20010, United States
Cristiane Gomes-Lima, Kenneth Burman, Department of Endocrinology, MedStar Washington Hospital Center, Washington, DC 20010, United States
Eshetu Tefera, Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Washington, DC 20010, United States
Mairead Baker, Saira Farid, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, United States
Mamta Sherchan, Florina Constantinescu, Department of Rheumatology, MedStar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: Peravali M, Gomes-Lima C, Burman K, Constantinescu F, and Veytsman I designed the research study; Peravali M, Gomes-Lima C, Baker M, Sherchan M, Farid S, and Veytsman I collected data for research; Tefera E provided biostatistics and analysis of data; Peravali M, Gomes-Lima C, Burman K, Tefera E, and Veytsman I wrote and revised the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the MedStar Health Research Institute Ethics Committee. Approved IRB code STUDY00001266.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Monica Peravali, MD, Academic Fellow, Department of Hematology/ Oncology, MedStar Washington Hospital Center, 110 Irving Street, Washington, DC 20010, United States.
Received: December 14, 2020
Peer-review started: December 14, 2020
First decision: December 24, 2020
Revised: January 4, 2021
Accepted: January 21, 2021
Article in press: January 21, 2021
Published online: February 24, 2021
Research background

Immune checkpoint inhibitors (ICPi) constitute a revolutionary therapy for various types of cancer. However, their use is associated with the development of several immune-related adverse events (irAEs), especially related to the endocrine system.

Research motivation

Recently, some studies have suggested that the development of irAEs could result in improved survival outcome.

Research objectives

This retrospective study aimed to describe the association of development of irAEs to survival outcomes in patients treated with ICPi for advanced stage solid malignancies. Moreover, we investigated the effects of endocrine irAEs on survival and we addressed differences in survival outcomes among different racial groups.

Research methods

This is a retrospective analysis of data on 293 patients with diagnosis of stage IV solid malignancy who were treated with programmed cell death-protein 1 or programmed death ligand 1 blocker between 1 January 2013 and 31 December 2018. Progression free survival and overall survival were primary endpoints.

Research results

Out of 293 patients, 91 (31%) had any grade irAEs, amongst which the most common were endocrine (40.7%), followed by dermatological (23.1%) and rheumatologic (18.7%). Caucasians had more irAEs than African Americans (60.4% vs 30.8%). Patients with irAE had a lower rate of progression (30.8% vs 46.0%, P = 0.0140). Median progression free survival was higher in patients with irAE vs those without (5.8 vs 3.0 mo respectively, P = 0.02). Similarly, median overall survival was higher in those with irAE vs no irAE (17.1 vs 7.2 mo respectively, P < 0.0001).

Research conclusions

This study demonstrates that the development of irAEs is positively correlated with improved survival. It also demonstrates a positive correlation with Caucasian race and overall survival.

Research perspectives

Future prospective studies designed to evaluate cofounding variables for survival such as type of ICPi used, tumor type, and line of treatment are needed to draw definitive conclusions.