Analysis and management experience summary of immune-related adverse events in 136 gynecologic malignancies patients.

Abstract

e17500 Background: The use of ICIs can lead to the occurrence of immune-related adverse events (irAEs), which result from non-specific reactions generated by the immune system that can affect nearly all tissues and organs. Methods: This study is a retrospective clinical study that collected data from 626 gynecologic malignancy patients treated with ICIs at our center from January 2019 to July 2024. The ICIs included anti-PD-1, anti-PD-L1, and dual antibodies (anti-PD-1 + CTLA-4), used either as monotherapy or in combination with chemotherapy, radiotherapy, or targeted therapy. The median observation period was 19 months (range 1-52 months). Results: The study results showed that a total of 136 patients experienced varying degrees of irAEs, with an overall incidence of 21.73% (136/626). The proportion of irAEs by affected organ was as follows: endocrine system (53.67%), heart (14.70%), skin (11.76%), lungs (8.09%), gastrointestinal tract (5.88%), muscles (5.14%), liver (3.67%), nervous system (2.20%), blood (1.47%), and pancreas (0.73%). The incidence of grade 1-2 irAEs was 17.73%, while the incidence of grade 3-4 was 3.99%. The median number of treatment courses for overall irAEs was 3 courses (range 1-23), and the median time to onset was 9 weeks (range 1-64). The main treatment for irAEs involved the intravenous infusion of methylprednisolone, administered once daily. There were no deaths caused by irAEs. Conclusions: The organ most affected by irAEs is the thyroid, followed by the heart. Timely application of glucocorticoid to block irAEs, with an adequate initial dose, is key to treatment. When serious side effects occur in vital organs and diagnosis is difficult, empirical glucocorticoid treatment is necessary. Management of irAEs. Drug Category Percentage(N a =136 cases） System corticosteroid 48.53% (66/136) Methylprednisolone 47.06% (64/136) Hydrocortisone 2.94% (4/136) Dexamethasone 0.74% (1/136) Mycophenolate ester 2.21% (3/136) Infliximab 0.74% (1/136) Topical Hydrocortisone 4.41% (6/136) Nonsteroidal Treatment 52.21% (71/136) Insulin 1.47% (2/136) Thyroxine(Levothyroxine sodium) 50% (68/136) Thyroxine inhibitor(Thiamazole) 0.74% (1/136) a: irAEs patients: N=136 cases.