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@ARTICLE{Ruf:289667,
author = {T. Ruf and R. Kramer and A. Forschner and U. Leiter and F.
Meier and L. Reinhardt and P. Dücker and C. Ertl and D.
Tomsitz and J. K. Tietze and R. Gutzmer and E. Dabrowski and
L. Zimmer$^*$ and A. Gesierich and S. Zierold and L. E.
French and T. Eigentler and T. Amaral and L. Heinzerling},
title = {{S}econd-line therapies for steroid-refractory
immune-related adverse events in patients treated with
immune checkpoint inhibitors.},
journal = {European journal of cancer},
volume = {203},
issn = {0014-2964},
address = {Amsterdam [u.a.]},
publisher = {Elsevier},
reportid = {DKFZ-2024-00849},
pages = {114028},
year = {2024},
abstract = {Immune checkpoint inhibitors (ICI) induce adverse events
(irAEs) that do not respond to steroids, i.e.
steroid-refractory (sr) irAEs, and irAEs in which steroids
cannot be tapered, i.e. steroid-dependent (sd) irAEs, in
about $10\%$ of cases. An evidence-based analysis of the
effectiveness of second-line immunosuppressive agents with
regard to irAE and tumor control is lacking.The
international web-based Side Effect Registry Immuno-Oncology
(SERIO; http://serio-registry.org) is a collaborative
initiative with the Paul-Ehrlich-Institute to document rare,
severe, complex or therapy-refractory immunotherapy-induced
side effects. The registry was queried on August 1, 2023 for
cases of irAEs which were treated with second-line
therapies.From a total of 1330 cases, 217 patients
$(16.3\%)$ received 249 second-line therapies. A total of 19
different second-line therapies were employed, including
TNF-alpha antagonists $(46.5\%),$ intravenous
immunoglobulins (IVIG; $19.1\%),$ mycophenolate mofetil
$(15.9\%),$ and methotrexate $(3.6\%).$ Therapy choices were
determined by the type of irAE. The time to onset of
sr-/sd-irAEs after ICI initiation did not consistently
differ from steroid-responsive irAEs. While $74.3\%$ of
sr-/sd-irAEs resolved and $13.1\%$ had improved, $4.3\%$
persisted, $3.9\%$ resulted in permanent sequelae, and
$4.3\%$ in death with ongoing symptoms. Infliximab exhibited
potential for earlier symptom improvement compared to
mycophenolate mofetil or IVIG. Tumor response in patients
with second-line treated sd-/sr-irAE was similar to patients
with irAEs treated with steroids only.Several second-line
therapies are effective against sr-/sd-irAEs, the
second-line therapies show no clear negative impact on tumor
response, and infliximab shows potential for faster
improvement of symptoms. However, prospective comparative
data are needed.},
keywords = {Immune checkpoint inhibitors (Other) / Immune-related
adverse events (Other) / Second-line immunosuppressants
(Other) / Steroid-dependent (Other) / Steroid-refractory
(Other)},
cin = {ED01},
ddc = {610},
cid = {I:(DE-He78)ED01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:38652976},
doi = {10.1016/j.ejca.2024.114028},
url = {https://inrepo02.dkfz.de/record/289667},
}