Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia / Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy

OBJETIVO: Identificar la incidencia de reacciones adversas inmunomediadas (irAE, immune related adverse events), con y sin manifestaciones radiológicas, y correlacionarla con la respuesta al tratamiento inmunoterápico. MATERIAL Y MÉTODOS: Se reclutaron retrospectivamente 79 pacientes con carcinomas de pulmón (n=24), renal (n=11) y melanoma (n=44) en estadio IV que fueron tratados con fármacos inmunoterápicos. Se valoró la aparición de irAE, sus manifestaciones radiológicas y el tipo de patrón de respuesta de acuerdo con los criterios de respuesta a la inmunoterapia (irRC). Se relacionó la presencia de irAE con el patrón de respuesta al tratamiento. RESULTADOS: El 27,8% de los pacientes sufrieron irAE. Estas reacciones fueron más frecuentes en pacientes con melanoma (40,9% de los pacientes). Más de la mitad de las reacciones (59,1%) presentaron manifestaciones radiológicas a modo de neumonitis, colitis, hipofisitis, tiroiditis y miocarditis. La neumonitis fue la irAE con expresión radiológica más frecuente, incluso en pacientes asintomáticos. En la población estudiada, la tasa de respuesta a la inmunoterapia fue significativamente mejor en pacientes que desarrollaron irAE (68,2% frente a 38,6%, χ2=5,58; p = 0,018). La tasa de respuesta favorable en los pacientes con y sin manifestaciones radiológicas de las irAE fue de 84,6% y 44,4%, respectivamente (p = 0,023). CONCLUSIONES: La presencia de reacciones adversas inmunomediadas se asocia, de forma significativa, con una mejor respuesta a la inmunoterapia. La asociación con respuesta favorable es incluso mayor en pacientes con manifestaciones radiológicas de las irAE

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p = 0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p = 0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions

Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy. / Reacciones adversas inmunomediadas como predictoras de respuesta en pacientes oncológicos en tratamiento con inmunoterapia.

OBJECTIVE: To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS: We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS: Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023). CONCLUSIONS: The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.