Use of steroid-sparing agents (SSAs) for immune-related adverse events (irAEs) in patients (pts) discussed at a multidisciplinary immune-related adverse event (irAE) tumor board.

Abstract

e24112 Background: SSAs are standard of care for steroid-refractory irAEs from immune checkpoint inhibitors. Due to the paucity of high-quality evidence, guidelines are based on expert consensus. Steroid-refractory irAEs are best managed through multidisciplinary collaboration. It is currently unknown whether an institutional irAE tumor board is an effective tool to facilitate multidisciplinary management of severe irAEs requiring SSAs. Methods: We performed a retrospective review of pts discussed at our multidisciplinary irAE tumor board at Cleveland Clinic Taussig Cancer Center since the establishment of irAE tumor board in 2017. The irAE tumor board meets virtually twice monthly. A medical oncologist attends each irAE tumor board. Our data scientist reviews requested cases in advance and coordinates attendance of the subspecialists and presenting physician for each pt. Data regarding irAEs and tumor board recommendations were collected using the electronic medical record system. Results: Between 2017- 2024, 166 pts (83 female, 83 male) were discussed at irAE tumor boards. 31/166 pts (18.7%) received an SSA for the irAE discussed at tumor board. An additional 16 pts (9.6%) received a SSA for an irAE affecting a different organ system than what was discussed at tumor board. Of the 31 pts who received a biologic for the irAE discussed at tumor board, 18 pts (18/31 58.1%, 18/167 total pts 10.8%) received the SSA after tumor board. The most common irAEs requiring SSAs were gastrointestinal, including colitis, hepatitis, gastritis, and pancreatitis (53.2%, 25/47). Other common irAEs requiring SSAs were rheumatologic (14.9%, 7/47), neurologic (12.8%, 6/47), and dermatologic (10.6%, 5/47). The most common SSAs used were infliximab (36.2%, 17/47), IVIG (17.2%, 8/47) and hydroxychloroquine (14.9%, 7/47). The number of pts who received a SSA at any point each year were as follows: 2017: 4/13 (30.8%), 2018: 8/30 (26.7%), 2019: 6/17 (35.5%), 2020: 6/25 (24%), 2021: 9/33 (27.3%), 2022: 5/16 (31.3%), 2023: 5/17 (29.4%), 2024: 4/15 (26.7%). The number of pts who received a SSA specifically discussed at irAE tumor board each year was as follows: 2017: 3/13 (23.1%), 2018: 5/30 (16.7%), 2019: 5/17 (29.4%), 2020: 4/25 (16%), 2021: 6/33 (15.2%), 2022: 3/16 (18.8%), 2023: 3/17 (17.6%), 2024: 3/15 (20%). Conclusions: Our institutional irAE tumor board provides a forum for multidisciplinary collaboration for pts who develop steroid-refractory irAEs requiring SSAs. A high fraction of pts presented at irAE tumor board required SSAs, either for the irAE discussed at tumor board or for another irAE. This high utilization of SSAs remained stable over time and confirms the importance of accessible and timely multidisciplinary collaboration in pts who develop irAEs.