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Association of Anti-TNF with Decreased Survival in Steroid Refractory Ipilimumab and Anti-PD1-Treated Patients in the Dutch Melanoma Treatment Registry.

Association of Anti-TNF with Decreased Survival in Steroid Refractory Ipilimumab and Anti-PD1-Treated Patients in the Dutch Melanoma Treatment Registry.

Authors :
Verheijden RJ
May AM
Blank CU
Aarts MJB
van den Berkmortel FWPJ
van den Eertwegh AJM
de Groot JWB
Boers-Sonderen MJ
van der Hoeven JJM
Hospers GA
Piersma D
van Rijn RS
Ten Tije AJ
van der Veldt AAM
Vreugdenhil G
van Zeijl MCT
Wouters MWJM
Haanen JBAG
Kapiteijn E
Suijkerbuijk KPM
Source :
Clinical cancer research : an official journal of the American Association for Cancer Research [Clin Cancer Res] 2020 May 01; Vol. 26 (9), pp. 2268-2274. Date of Electronic Publication: 2020 Jan 27.
Publication Year :
2020

Abstract

Purpose: Unleashing the immune system by PD-1 and/or CTLA-4 blockade can cause severe immune-related toxicity necessitating immunosuppressive treatment. Whether immunosuppression for toxicity impacts survival is largely unknown.<br />Experimental Design: Using data from the prospective nationwide Dutch Melanoma Treatment Registry (DMTR), we analyzed the association between severe toxicity and overall survival (OS) in 1,250 patients with advanced melanoma who were treated with immune checkpoint inhibitors (ICI) in first line between 2012 and 2017. Furthermore, we analyzed whether toxicity management affected survival in these patients.<br />Results: A total of 1,250 patients were included, of whom 589 received anti-PD1 monotherapy, 576 ipilimumab, and 85 combination therapy. A total of 312 patients (25%) developed severe (grade ≥3) toxicity. Patients experiencing severe ICI toxicity had a significantly prolonged survival with a median OS of 23 months compared with 15 months for patients without severe toxicity [hazard ratio (HR <subscript>adj</subscript> ) = 0.77; 95% confidence interval (CI), 0.63-0.93]. Among patients experiencing severe toxicity, survival was significantly decreased in patients who received anti-TNF ± steroids for steroid-refractory toxicity compared with patients who were managed with steroids only (HR <subscript>adj</subscript> = 1.61; 95% CI, 1.03-2.51), with a median OS of 17 and 27 months, respectively.<br />Conclusions: Patients experiencing severe ICI toxicity have a prolonged OS. However, this survival advantage is abrogated when anti-TNF is administered for steroid-refractory toxicity. Further prospective studies are needed to assess the effect of different immunosuppressive regimens on checkpoint inhibitor efficacy. See related commentary by Weber and Postow, p. 2085 .<br /> (©2020 American Association for Cancer Research.)

Details

Language :
English
ISSN :
1557-3265
Volume :
26
Issue :
9
Database :
MEDLINE
Journal :
Clinical cancer research : an official journal of the American Association for Cancer Research
Publication Type :
Academic Journal
Accession number :
31988197
Full Text :
https://doi.org/10.1158/1078-0432.CCR-19-3322