Prevalence of Cutaneous and Oral Immune-Related Adverse Events Related to Immune Checkpoint Inhibitor Therapy in a Single Institution

Objectives To analyze the prevalence of cutaneous and oral immune-related adverse events (irAEs) in cancer patients treated with immune checkpoint inhibitor (ICI) therapy. Methods This retrospective study reviewed electronic medical records of patients at A.C. Camargo Cancer Center who received ICI therapy between January 2016 and May 2022. Descriptive statistics were analyzed using Microsoft Excel. Results A total of 748 patients (59.3% male) with a mean age of 65 years were included in the analysis. The most common cancer diagnoses included lung carcinoma (n= 196, 26.2%), melanoma (n=171, 22.8%), head and neck cancer (n= 77, 10.2%), and kidney cancer (n= 76, 10.1%). Most patients had advanced stage (IV) disease (n= 486, 64.9%). The most common ICI was pembrolizumab (n= 351, 46.9%) followed by the combination of ipilimumab + nivolumab (n=142, 18.9%), and most patients were treated without adjuvant chemotherapy or targeted therapies (n=572, 76.4%). The majority of patients (n=414, 55.3%) developed cutaneous irAES, with pruritus (n=330, 79.7%) being the most frequently observed. Only 17.6% of patients (n=132) experienced oral irAEs; of those, mucosal disorders (n=84, 63.67%), xerostomia (n=70, 53%), or both (n=22,16.6%) were reported. The median onset of cutaneous and oral irAES was observed 78 and 120 days after initiating ICI therapy, respectively. Ninety-six patients presented simultaneous involvement; in 54 cases, they first manifested in the skin, whereas in 42 cases they first appeared in the oral cavity. Severity and frequency for cutaneous irAEs were I (n=264, 63.7%), II (n=130, 31.4%), III (n=19, 4.5%), and IV (n=1, 0.2%), and for oral mucosal disorders and xerostomia I (n=51/49, 60.7/70%), II (n=25/21, 29.7/30%), III (n=7/0 8.3/0%), and IV (n=1/0, 1.2/0%), respectively. Conclusions Cutaneous toxicities were more common and may arise earlier than oral irAEs in patients treated with ICIs. Such effects presented low severity for the patients. In around 13% of patients, ICI-related irAES occurred concomitantly, resulting in a mucocutaneous presentation. To analyze the prevalence of cutaneous and oral immune-related adverse events (irAEs) in cancer patients treated with immune checkpoint inhibitor (ICI) therapy. This retrospective study reviewed electronic medical records of patients at A.C. Camargo Cancer Center who received ICI therapy between January 2016 and May 2022. Descriptive statistics were analyzed using Microsoft Excel. A total of 748 patients (59.3% male) with a mean age of 65 years were included in the analysis. The most common cancer diagnoses included lung carcinoma (n= 196, 26.2%), melanoma (n=171, 22.8%), head and neck cancer (n= 77, 10.2%), and kidney cancer (n= 76, 10.1%). Most patients had advanced stage (IV) disease (n= 486, 64.9%). The most common ICI was pembrolizumab (n= 351, 46.9%) followed by the combination of ipilimumab + nivolumab (n=142, 18.9%), and most patients were treated without adjuvant chemotherapy or targeted therapies (n=572, 76.4%). The majority of patients (n=414, 55.3%) developed cutaneous irAES, with pruritus (n=330, 79.7%) being the most frequently observed. Only 17.6% of patients (n=132) experienced oral irAEs; of those, mucosal disorders (n=84, 63.67%), xerostomia (n=70, 53%), or both (n=22,16.6%) were reported. The median onset of cutaneous and oral irAES was observed 78 and 120 days after initiating ICI therapy, respectively. Ninety-six patients presented simultaneous involvement; in 54 cases, they first manifested in the skin, whereas in 42 cases they first appeared in the oral cavity. Severity and frequency for cutaneous irAEs were I (n=264, 63.7%), II (n=130, 31.4%), III (n=19, 4.5%), and IV (n=1, 0.2%), and for oral mucosal disorders and xerostomia I (n=51/49, 60.7/70%), II (n=25/21, 29.7/30%), III (n=7/0 8.3/0%), and IV (n=1/0, 1.2/0%), respectively. Cutaneous toxicities were more common and may arise earlier than oral irAEs in patients treated with ICIs. Such effects presented low severity for the patients. In around 13% of patients, ICI-related irAES occurred concomitantly, resulting in a mucocutaneous presentation.