Chronic immunotherapy-related complications are more prevalent and persistent than previously shown among melanoma survivors, according to new research published Aug. 3 in JAMA Network Open.
Almost one-third (29.2%) of patients treated with either pembrolizumab or nivolumab experienced prolonged complications from the immunotherapies. The researchers analyzed data from 318 melanoma patients from six medical centers in the United States and Australia who received at least 18 months of follow-up care.
The findings from this cohort study suggest clinicians should provide prolonged monitoring of patients after treatment with anti-PD-1 therapy and, also, consider risk-benefit analysis before treatment. The study has relevance beyond melanoma, which was one of the first cancers for which immunotherapies were approved, because anti-PD-1 therapies have proven effective for a wider array of cancers.
“Although common, long-term side effects tended to be mild or, in the case of decreased thyroid or adrenal hormone, asymptomatic, a subset of side effects also continued to improve over time,” said the study’s senior author, Douglas Johnson, MD, MSCI, clinical director of melanoma at Vanderbilt-Ingram Cancer Center and holder of the Susan and Luke Simons Directorship.
The complications occur when the immunotherapies cause inflammation that can affect not only the cancer, but several organs as well. Physicians prescribe steroids to alleviate this overreaction. The most common persistent complications among the patients who experienced immune-related adverse events were hypothyroidism (70.4%), arthritis (33.3%), dermatitis (16.7%) and adrenal insufficiency (14.8%). Some complications persisted longer than others. Eighty percent of patients still had adrenal insufficiency within one-and-a-half years of follow-up.
The study’s lead author is Rachel Goodman, MBA, a medical student mentoring under Johnson. She received support from the Burroughs Wellcome Fund from the SCRIPS Foundation. Johnson received support from the Scripps Health Foundation, the National Cancer Institute (CA227481), the Susan and Luke Simons Directorship, the James C. Bradford Melanoma Fund and the Van Stephenson Melanoma Fund.