Multiorgan immune-related adverse events during treatment with atezolizumab

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Background:Immune-related adverse events (irAEs) are known to occur in patients with cancer who are treated with immune check-point inhibitors. However, limited literature exists on the incidence,time of onset, and risk factors for irAEs, particularly those affecting multiple organs, associated with anti–PD-L1 inhibitors.Methods:A post hoc pooled analysis was conducted using individual patient data from atezolizumab monotherapy arms of 4 non–small cell lung cancer clinical trials. Incidence, clinical patterns, outcomes, and risk factors were investigated of selected organ-specific and multiorgan irAEs during treatment using the anti–PD-L1 inhibitor atezolizumab.Results:From a total of 1,548 patients, 730 irAE episodes were reported in 424 patients (27%). Skin irAEs were the most common(42%), followed by laboratory abnormalities (27%) and endocrine(11.6%), neurologic (7.6%), and pulmonary (6.2%) irAEs. A total of84 patients (5.4%) had multiorgan irAEs, 70 had 2, 13 had 3, and 1 had4 different organs affected.“Skin plus”or“laboratory plus”were the most common irAE multiorgan clusters. Patients with multiorganirAEs were more likely to be white and have a good performance status, a lower baseline neutrophil-lymphocyte ratio, and a good or intermediate lung immune prognostic index score. Multiorgan irAEswere also associated with improved overall survival (hazard ratio,0.47; 95% CI, 0.28–0.78;P,.0001) but not with progression-freesurvival (hazard ratio, 0.92; 95% CI, 0.62–1.35;P5.74) compared with the cohort with no irAEs.Conclusions:Multiorgan irAEs oc-curred in 5.4% of patients treated with atezolizumab in non–small cell lung cancer trials. Future trials should consider routine reporting of data on multiorgan toxicities in addition to organ-specific toxicities

Original languageEnglish
Pages (from-to)1191-1199
Number of pages9
JournalJournal of the National Comprehensive Cancer Network
Issue number9
Publication statusPublished - Sep 2020


  • irAEs
  • Atezolizumab
  • Immune checkpoint inhibitors (ICIs)
  • immune effector T cells

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