PD-1 Immune Checkpoint Inhibitors and Immune-Related Adverse Events: a Cohort Study
Overview
- Phase
- Not Applicable
- Intervention
- PD-1 inhibitor
- Conditions
- Carcinoma, Non-Small-Cell Lung
- Sponsor
- Sungkyunkwan University
- Enrollment
- 4724
- Primary Endpoint
- Hazard ratio for immune-related adverse events
- Last Updated
- 5 years ago
Overview
Brief Summary
The objective of our study is to assess the risk of immune-related adverse events associated with PD-1 inhibitors use compared to standard chemotherapy use in patients with non small cell lung cancer, using nationwide healthcare database.
Detailed Description
This observational, retrospective cohort study will evaluate the risk of immune-related adverse events associated with PD-1 inhibitors use compared to standard chemotherapy use in patients with non small cell lung cancer, using nationwide healthcare database. PD-1 inhibitors will be defined as nivolumab, pembrolizumab, and atezolizumab. Standard chemotherapy will be defined as cytotoxic chemotherapy or tyrosine kinase inhibitors (epidermal growth cell receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors). The investigators will assess exposure on the cohort entry using the intention-to-treat approach with the 6-month exposure risk window from the first PD-1 inhibitor prescription to avoid bias from informative censoring. Immune-related adverse events will be defined by using pre-specified algorithms using diagnosis and corticosteroid prescription records (high dose of oral corticosteroids, defined as ≥ 30 mg/day, or systemic corticosteroid injection) to reduce outcome misclassification. The investigators will use a multivariable Cox proportional hazard model to estimate hazard ratio (HR) and 95% confidence intervals (CI). The model will be adjusted for pre-existing autoimmunity, history of lung cancer surgery, radiation therapy, tyrosine kinase inhibitor use, and previous systemic corticosteroid use. All analyses will be undertaken using SAS 9.4 (SAS Institute Inc., Cary, NC, USA).
Investigators
Ju-Young Shin
Assistant Professor
Sungkyunkwan University
Eligibility Criteria
Inclusion Criteria
- •Individuals who were diagnosed with lung cancer (ICD-10: C33-C34) between 2017 and 2018.
Exclusion Criteria
- •Individuals less than 18 years of age
- •Individuals received any systemic anticancer therapies in 2007
- •Having no records of prescription of PD-1 inhibitors or standard chemotherapy at least once between 2017 and 2018
- •Individuals received treatments indicated for small cell lung cancer (etoposide, ifosfamide, irinotecan, belotecan, and topotecan) on or before the first date of standard chemotherapy to restrict study subjects to patients with non small cell lung cancer only.
Arms & Interventions
PD-1 inhibitor
Patients over 18 years of age with a diagnosis of non-small cell lung cancer and being received PD-1 inhibitors as a second line treatment from cytotoxic chemotherapy or as a third line for those received tyrosine kinase inhibitors as a first line, from August 2017 (the first month PD-1 inhibitors were reimbursed in South Korea) to September 2018.
Intervention: PD-1 inhibitor
Chemotherapy Drugs, Cancer
Patients over 18 years of age with a diagnosis of non-small cell lung cancer and being received cytotoxic chemotherapy or tyrosine kinase inhibitors (epidermal growth cell receptor (EGFR) and anaplastic lymphoma kinase (ALK) inhibitors) from August 2017 to September 2018. Each patient switching to PD-1 inhibitor will be matched to three reference standard chemotherapy users.
Intervention: Chemotherapy Drugs, Cancer
Outcomes
Primary Outcomes
Hazard ratio for immune-related adverse events
Time Frame: August 2017 to December 2018
The ratio of hazard rates of immune-related adverse events in PD-1 inhibitor users vs. standard chemotherapy users
Secondary Outcomes
- Hazard ratio for eleven subdivided groups of immune-related adverse events by organ class(August 2017 to December 2018)