Retrospective cohort study of impact of immune-related and non-immune related hospital admission on survival with first-line immunotherapy for mNSCLC

Patients with metastatic non-small cell lung cancer (mNSCLC) treated with immune checkpoint inhibitors (ICIs) are at risk for immune-related adverse events (irAEs). A retrospective study at The Ohio State University (Columbus) evaluated the survival impact of irAE-related hospitalization compared with hospitalizations for other reasons among mNSCLC patients receiving first-line pembrolizumab with or without chemotherapy. Among 312 patients treated from 2017 to 2022, 203 (65%) were hospitalized for any reason within 1 year of initiating pembrolizumab, including 37 (12%) for irAEs. The most common reasons for irAE-related hospitalization were pneumonitis and colitis. Patients with irAE-related hospitalization had significantly shorter median overall survival (8.6 months; 95% CI 5.0-19.9) compared with those hospitalized for other reasons (22.7 months; 95% CI 18.2-27.4; p=0.027). Patients who were hospitalized for early-onset irAE (<6 months) had significantly shorter median OS (5.4 months; 95% CI 2.7-8.6) compared to patients hospitalized forlate-onset irAE (median not reached; mediane 8.6-NR; p=0.003). Patients hospitalized for any reason during the first year of treatment had shorter median OS (11.2 months; 95% CI 9.5-15.2) than those who were not (49.4 months; 95% CI 39.5-62.4; p<0.001). The authors conclude that severe irAEs requiring hospitalization or hospitalization for any cause within the first year of initiating pembrolizumab among patients with mNSCLC was associated with worse survival outcomes.