993 Optimizing management of immune checkpoint inhibitor-mediated toxicity in cancer patients
Year: 2026
Type: conference-abstract
Abstract: Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment across multiple tumor types, providing survival benefits in several metastatic cancers. However, they can also induce life-threatening immune-related adverse events (irAEs). 1 Delayed diagnosis not only leads to increased morbidity and mortality but also necessitates early discontinuation of ICI, leading to adverse oncologic outcomes.2 This quality improvement project aimed to characterize ICI-mediated toxicities among patients treated at Northwell Health and design strategies for efficient management of toxicity.Methods We conducted a retrospective review of adult patients with cancer treated with ICIs at Northwell Health between October 2023 and March 2025. Demographics, cancer type, comorbidity, prevalence of irAEs, treatment discontinuation, and treatment response were assessed among individuals with irAEs versus those without irAEs.Results Among 114 patients treated with ICIs, 56.1% experienced an irAE, with pembrolizumab being the most commonly used agent. The cohort was predominantly female (59.7%) and Caucasian (67.5%). Thoracic malignancies were the most common cancer type (37.7%), followed by gynecologic (17.5%), and genitourinary (13.2%) cancers. The distribution of immunotherapy agents was similar between patients who developed irAEs and those who did not. Gastrointestinal and endocrine toxicities were the most frequent toxicities, occurring in 31.0% and 26.5% of cases, respectively. Colitis was the most common gastrointestinal toxicity. Comorbid diagnoses did not differ by irAE toxicity status. Among patients who developed toxicity, 26.6% were detected early after treatment initiation, most often through monthly laboratory surveillance.Conclusions There was a higher rate of toxicity than reported in previous studies, with 56.1% of patients experiencing toxicity. Laboratory monitoring played an important role in early irAE detection, with many toxicities identified before progressing beyond grade 1 or grade 2 severity. These findings suggest that routine laboratory surveillance plays an important role in early irAE detection and may allow for earlier intervention before progression to severe toxicity. Future directions include designing strategies and workflows for efficient management of ICI-mediated toxicity in cancer patients.References Tacchi C, Convertino I, Bocci G. Immune-related adverse events associated with immune checkpoint inhibitors: a scoping review. Pharmaceuticals (Basel) 2026;19(2):276.Ohta R, Ryu Y, Tanaka K, Sano C, Hayashi H. Initial symptoms and diagnostic delay in immune checkpoint inhibitor-related adrenal insufficiency: a systematic review and meta-ethnography of case reports. Front Endocrinol (Lausanne). 2025;16:1636452.Ethics Approval This study was approved by the Northwell Health Institutional Review Board.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,490
OpenAlex ID: W7225154197