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. 2020 Dec;8(2):e001622.
doi: 10.1136/jitc-2020-001622.

Safety of immune checkpoint inhibitor rechallenge after discontinuation for grade ≥2 immune-related adverse events in patients with cancer

Marion Allouchery  1 , Thomas Lombard  2 , Mickael Martin  3   4 , Franck Rouby  5 , Marion Sassier  6   7 , Celia Bertin  8 , Marina Atzenhoffer  9 , Ghada Miremont-Salame  10   11 , Marie-Christine Perault-Pochat  1   12   13 , Mathieu Puyade; French Network of Regional Pharmacovigilance Centers
Affiliations

Safety of immune checkpoint inhibitor rechallenge after discontinuation for grade ≥2 immune-related adverse events in patients with cancer

Marion Allouchery et al. J Immunother Cancer. 2020 Dec.

Erratum in

Abstract

Background: Safety of rechallenge of immune checkpoint inhibitor (ICI) after grade ≥2 immune-related adverse events (irAEs) leading to ICI discontinuation remains unclear.

Methods: All adverse drug reactions involving at least one ICI reported up to December 31, 2019 were extracted from the French pharmacovigilance database. Patients were included if they experienced at least one grade ≥2 irAE resulting in ICI discontinuation, with subsequent ICI rechallenge. The primary outcome was the recurrence of at least one grade ≥2 irAE in these patients after ICI rechallenge.

Results: We included 180 patients: 61.1% were men (median age of 66 years), 43.9% had melanoma and 78.9% were receiving anti-programmed cell death 1. First ICI discontinuation was related to 191 irAEs. After ICI rechallenge, 38.9% of the patients experienced at least one grade ≥2 irAE. Among them, 70.0% experienced the same irAE, 25.7% a distinct irAE, and 4.3% both the same and a distinct irAE. Lower recurrence rates of irAEs were associated with rechallenge with the same ICI treatment (p=0.02) or first endocrine irAEs (p=0.003). Gastrointestinal irAEs were more likely to recur (p=0.007). The median duration from ICI discontinuation to rechallenge and the severity of the initial irAE did not predict recurrent irAEs after ICI rechallenge (p=0.53 and p=0.40, respectively).

Conclusions: In this study, 61.1% of the patients who discontinued ICI treatment for grade ≥2 irAEs experienced no recurrent grade ≥2 irAEs after ICI rechallenge. Although ICI rechallenge appears to be safe under close monitoring, it should always be discussed balancing usefulness of rechallenge, patient comorbidities and risk of recurrence of first irAE(s). Due to inherent bias associated with pharmacovigilance studies, further prospective studies are needed to assess risk factors that may influence patient outcomes after ICI rechallenge.

Keywords: autoimmunity; immunotherapy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart. ADR, adverse drug reaction; FPVD, French pharmacovigilance database; ICI, immune checkpoint inhibitor; irAE, immune-related adverse event.
Figure 2
Figure 2
Patient outcomes after immune checkpoint inhibitor rechallenge according to the type of irAEs. irAE, immune-related adverse event.
See this image and copyright information in PMC

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