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ICU admission for solid cancer patients treated with immune checkpoint inhibitors

par Toffart, Anne-Claire;Meert, Anne-Pascale ;Wallet, Florent;Gibelin, Aude;Guisset, Olivier;Gonzalez, Frédéric;Seguin, Amélie;Kouatchet, Achille;Delaunay, Myriam;Debieuvre, Didier;Duchemann, Boris;Rousseau-Bussac, Gaelle;Nyunga, Martine;Grimaldi, David ;Levrat, Albrice;Azoulay, Elie;Lemiale, Virginie
Référence Annals of intensive care, 13, 1, 29
Publication Publié, 2023-12

Article révisé par les pairs

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Résumé :

Background: Immune checkpoint inhibitors (ICI) have revolutionized the management of cancer. They can induce immune-related adverse events (irAE) leading to intensive care unit (ICU) admission. We aimed to describe irAEs for ICU admissions in solid cancer patients treated with ICIs. Methods: This prospective multicenter study was conducted in France and Belgium. Adult patients with solid tumor and treated with systemic ICIs within the last 6 months, requiring non-programmed ICU admission were included. Patients admitted for microbiologically documented sepsis were excluded. Imputability of irAEs in ICU admissions was described according to the WHO-UMC classification system at ICU admission and at ICU discharge. The use of immunosuppressant treatment was reported. Results: 115 patients were eligible. Solid tumor was mainly lung cancer (n = 76, 66%) and melanoma (n = 18, 16%). They were mainly treated with an anti-PD-(L)1 alone (n = 110, 96%). Main ICU admission reasons were acute respiratory failure (n = 66, 57%), colitis (n = 14, 13%), and cardiovascular disease (n = 13, 11%). ICU admission was considered “likely” associated with irAE for 48% (n = 55) of patients. Factors independently associated with irAE were a good ECOG performance status (PS) (ECOG-PS of 0 or 1 vs. ECOG-PS of 2–3, odds ratio [OR] = 6.34, 95% confidence interval [95% CI] 2.13–18.90, and OR = 3.66, 95% CI 1.33–10.03, respectively), and a history of irAE (OR = 3.28, 95% CI 1.19–9.01). Steroids were prescribed for 41/55 (75%) patients with ICU admission “likely” related to irAE. Three patients were subsequently treated with immunosuppressants. Conclusion: IrAEs accounted for half of ICU admissions in cancer patients receiving ICIs. They could be treated with steroids. Identifying the imputability of irAEs in ICU admissions remains a challenge.