Immune checkpoint inhibitors have become the standard of care for many patients with advanced cancers; however, these medications cause cutaneous adverse events in 20% to 40% of all patients who receive them. A study by Tang et al published in JAMA Dermatology indicated that these side effects may actually be linked to better patient response to immune checkpoint inhibitor therapy, as well as improved survival.
Study Methods and Results
For the study, investigators accessed the TriNetX Diamond network, a database of health records and claims data from more than 200 million patients from the United States and Europe. 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. Pruritus, drug eruption, xerosis, nonspecific rashes, and appearance of any cutaneous immune-related adverse event were significantly protective of mortality, as were psoriasis and lichen planus/lichenoid dermatitis. Eczematous dermatitis, vitiligo, bullous pemphigoid, and Grover disease were all associated with strong protective clinical effects.
“These data provide oncologists and dermatologists with important prognostic information when counseling immunotherapy recipients on the clinical implications of the skin toxicities,” said senior author Yevgeniy R. Semenov, MD, an investigator in the Department of Dermatology at Massachusetts General Hospital. “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 vs 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.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
