Prophylactic Interventions to Prevent Severe Skin Toxicities in Patients With Non-Small Cell Lung Cancer Treated With Nivolumab + Ipilimumab With or Without Chemotherapy.

Abstract

Purpose: The frequent occurrence of immune-related adverse events during immune checkpoint inhibitor therapy for non-small cell lung cancer (NSCLC), particularly dermatologic toxicities, often necessitates treatment modifications and systemic corticosteroid use, negatively affecting patient outcomes. This study evaluated the impact of a multidisciplinary prophylactic intervention on the incidence of severe skin toxicities among patients receiving nivolumab + ipilimumab (NI) with or without chemotherapy.

Patients and methods: This single-center, retrospective, observational study included 154 treatment-naïve patients with NSCLC who received NI with or without chemotherapy. A comparison was made between skin toxicities and clinical outcomes before and after the implementation of a prophylactic intervention consisting of physician-prescribed medications, pharmacist-led patient education, and nurse-guided skincare. The primary end points were the incidence of grade 3 or higher skin toxicities, systemic corticosteroid use, and treatment discontinuation. Secondary end points included progression-free survival (PFS) and overall survival (OS).

Results: The incidence of grade 3 skin toxicities significantly decreased from 21% before the intervention to 8% after the intervention (P = .045). Systemic corticosteroid use and treatment discontinuation rates due to skin toxicities reduced from 36% to 10% (P = .0004) and from 21% to 4% (P = .0012), respectively. Patients with any grade of skin rash exhibited significantly improved PFS and OS compared with those without skin toxicities. However, grade 3 toxicities were associated with poor OS.

Conclusion: Prophylactic interventions significantly reduced the severity of skin toxicities and enhanced treatment continuity in patients with NSCLC receiving nivolumab and ipilimumab-based therapy. These findings underscore the importance of proactive, multidisciplinary management strategies to optimize therapeutic outcomes.