TY - JOUR
T1 - Clinical Characteristics and Outcomes of Oral Mucositis Associated with Immune Checkpoint Inhibitors in Patients with Cancer
AU - Jacob, Jake S.
AU - Dutra, Barbara E.
AU - Garcia-Rodriguez, Victor
AU - Panneerselvam, Kavea
AU - Abraham, Fiyinfoluwa O.
AU - Zou, Fangwen
AU - Ma, Weijie
AU - Grivas, Petros
AU - Thompson, John A.
AU - Altan, Mehmet
AU - Glitza Oliva, Isabella C.
AU - Zhang, Hao Chi
AU - Thomas, Anusha S.
AU - Wang, Yinghong
N1 - Publisher Copyright:
© JNCCN-Journal of the National Comprehensive Cancer Network 2021
PY - 2021/12
Y1 - 2021/12
N2 - Background: Immune checkpoint inhibitor (ICI) therapy predisposes patients to immune-related adverse events (irAEs). Data are limited regarding the incidence, management, and outcomes of one such irAE: mucositis. In this study, we evaluated the clinical characteristics, disease course, treatment, and outcomes of ICI-mediated mucositis. Methods: This was a retrospective, single-center study of patients who received ICI therapy and developed oral mucositis at The University of Texas MD Anderson Cancer Center from January 2009 to September 2019. Inclusion criteria included age $18 years, a diagnosis of oral mucositis and/or stomatitis based on ICD-9 and ICD-10 codes, and therapy using CTLA-4 or PD-1/L1 inhibitors alone or combined with other agents. Results: We identified 152 patients with a mean age of 60 years, 51% of whom were men. Of the sample patients, 73% had stage IV cancer, with melanoma the most common (28%). Median time from ICI initiation to mucositis was 91 days. The most common clinical presentation of mucositis was odynophagia and/or oral pain (89%), 91% developed CTCAE grade 1-2 mucositis, and 78% received anti-PD-1/L1 monotherapy. Compared with anti-PD-1/L1-based therapy, anti-CTLA-4-based therapy was more frequently associated with earlier onset of mucositis (73 vs 96 days; P5.077) and a lower rate of symptom resolution (76% vs 92%; P5.029); 24% of patients required immunosuppressive therapy, which was associated with longer symptom duration (84 vs 34 days; P5.002) and higher mucositis recurrence rate (61% vs 32%; P5.006). ICI interruption was associated with worse survival (P5.037). Mucositis recurrence, immunosuppressant use, and presence of other irAEs did not affect survival. Conclusions: For ICI-mediated mucositis, a diagnosis of exclusion has not been well recognized and is understudied. Although the clinical symptoms of mucositis are mostly mild, approximately 25% of patients require immunosuppression. Mucositis recurrence can occur in approximately 39% patients. Our results showed that ICI interruption compromises overall survival.
AB - Background: Immune checkpoint inhibitor (ICI) therapy predisposes patients to immune-related adverse events (irAEs). Data are limited regarding the incidence, management, and outcomes of one such irAE: mucositis. In this study, we evaluated the clinical characteristics, disease course, treatment, and outcomes of ICI-mediated mucositis. Methods: This was a retrospective, single-center study of patients who received ICI therapy and developed oral mucositis at The University of Texas MD Anderson Cancer Center from January 2009 to September 2019. Inclusion criteria included age $18 years, a diagnosis of oral mucositis and/or stomatitis based on ICD-9 and ICD-10 codes, and therapy using CTLA-4 or PD-1/L1 inhibitors alone or combined with other agents. Results: We identified 152 patients with a mean age of 60 years, 51% of whom were men. Of the sample patients, 73% had stage IV cancer, with melanoma the most common (28%). Median time from ICI initiation to mucositis was 91 days. The most common clinical presentation of mucositis was odynophagia and/or oral pain (89%), 91% developed CTCAE grade 1-2 mucositis, and 78% received anti-PD-1/L1 monotherapy. Compared with anti-PD-1/L1-based therapy, anti-CTLA-4-based therapy was more frequently associated with earlier onset of mucositis (73 vs 96 days; P5.077) and a lower rate of symptom resolution (76% vs 92%; P5.029); 24% of patients required immunosuppressive therapy, which was associated with longer symptom duration (84 vs 34 days; P5.002) and higher mucositis recurrence rate (61% vs 32%; P5.006). ICI interruption was associated with worse survival (P5.037). Mucositis recurrence, immunosuppressant use, and presence of other irAEs did not affect survival. Conclusions: For ICI-mediated mucositis, a diagnosis of exclusion has not been well recognized and is understudied. Although the clinical symptoms of mucositis are mostly mild, approximately 25% of patients require immunosuppression. Mucositis recurrence can occur in approximately 39% patients. Our results showed that ICI interruption compromises overall survival.
UR - http://www.scopus.com/inward/record.url?scp=85122365153&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122365153&partnerID=8YFLogxK
U2 - 10.6004/JNCCN.2020.7697
DO - 10.6004/JNCCN.2020.7697
M3 - Article
C2 - 34348238
AN - SCOPUS:85122365153
SN - 1540-1405
VL - 19
SP - 1415
EP - 1424
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 12
ER -