Factors associated with immune-related adverse events in cancer patients treated with immunotherapy visiting the emergency department

Background

This study aimed to estimate the prevalence of immune-related adverse events (IRAEs) in patients treated with immune checkpoint inhibitors (ICI) who visited the emergency department (ED) and to identify patient characteristics associated with IRAEs.

Methods

This retrospective study included adult patients treated with ICI who visited the EDs of two University Hospitals between January 2017 and August 2024. The reason for emergency visit was attributed to IRAE if a diagnosis of IRAE was made during hospitalization or follow-up. Associations between explanatory variables (patient characteristics) and the outcome variable (presence of IRAE) were assessed using logistic regression and odds ratios (ORs) with 95 % confidence intervals [CI95 %].

Results

Among the 1330 patients who received ICI during the study period, 484 (36.4 %) visited the ED after treatment initiation, accounting for 898 visits. ED visits involved predominantly males (n = 573; 63.8 %), with median age of 64 years (IQR 54–73). The ED visits concerned most commonly patients with melanoma (n = 445, 49.6 %) and lung cancer (n = 409, 45.5 %). IRAE accounted for 135 (15 %) emergency visits. The most frequent IRAEs were digestive (31.5 %), endocrine (20.8 %), hepatic (13.7 %), neuromuscular (7.7 %), and pulmonary (6 %). Variables significantly associated with IRAE included male sex (OR: 1.67; 95 % CI: 1.07–2.60), diarrhea (OR: 3.96; 95 % CI: 2.42–6.49), and prior treatment with two (OR: 2.19; 95 % CI: 1.01–4.73) or three ICI drugs (OR: 3.59; 95 % CI: 1.46–8.82). Patients whose last ICI injection occurred more than six months before the emergency visit were less likely to experience IRAE (OR: 0.32; 95 % CI: 0.14–0.70).

Conclusion

This study reports that 36 % of patients with cancer treated with ICI visited the ED at some point after initiating treatment. These visits were related to IRAEs in 15 % of the cases. Diarrhea should prompt suspicion of IRAE (colitis), especially in patients who have received multiple ICI drugs within the last six months. Early recognition of IRAEs is important because early intervention may be associated with improved outcomes.