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Targeted Oncology

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05.07.2021 | Original Research Article

Risk of Infection with Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis

verfasst von: Fausto Petrelli, Anna Maria Morelli, Andrea Luciani, Antonio Ghidini, Cinzia Solinas

Erschienen in: Targeted Oncology | Ausgabe 5/2021

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Abstract

Background

The relative risk (RR) of infection for patients treated with immune checkpoint inhibitors (ICIs) is unknown.

Objectives

This study evaluated the risk of infection for patients with solid tumors undergoing ICI therapy based on a systematic review and meta-analysis.

Patients and Methods

The Cochrane Library, EMBASE, and Pubmed databases were searched up to 1 December 2020. Randomized trials comparing any ICI alone, with chemotherapy (CT), or with other agents versus placebo, CT, or other agents were included. Three independent reviewers extracted the data. The primary outcome was the RR of all-grade (G) and G3–5 infections for patients receiving ICI-based treatments. Random or fixed-effect models were used according to statistical heterogeneity.

Results

A total of 21,451 patients from N = 36 studies were eligible. ICIs were associated with a similar risk of all-grade infections (RR = 1.02; 95% CI 0.84–1.24; P = 0.85) versus non-ICI treatments (G1–5 events: 9.6 versus 8.3%). When the ICIs alone were compared to CT, their use was associated with 42% less risk of all-grade infections (RR = 0.58, 95% CI 0.4–0.85; P = 0.01). Compared to CT, the combination of ICIs and CT increased the risk of all-grade (RR = 1.37, 95% CI 1.23–1.53; P < 0.01) and severe infections (RR = 1.52, 95% CI 1.17–1.96; P < 0.01). In anti-PD-1, anti-PD-L1, anti-CTLA-4, monotherapy, and combination trials, the RR of all-grade infections was 0.72 (95% CI 0.49–1.05; P = 0.09), 1.18 (95% CI 0.95–1.46; P = 0.13), 1.74 (95% CI 1.13–2.67; P = 0.01), 0.97 (95% CI 0.79–1.19; P = 0.75) and 2.26 (95% CI 1.34–3.8; P < 0.01), respectively.

Conclusions

Compared to CT alone, ICIs were safer and are recommended for frail patients. Conversely, CT + ICIs or ICIs combinations increased infection risk. Further studies are required to identify high-risk patients and evaluate the need for CT dose reduction or prophylactic myeloid growth factors.

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Titel: Risk of Infection with Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis
verfasst von: Fausto Petrelli
Anna Maria Morelli
Andrea Luciani
Antonio Ghidini
Cinzia Solinas
Publikationsdatum: 05.07.2021
Verlag: Springer International Publishing
Erschienen in: Targeted Oncology / Ausgabe 5/2021
Print ISSN: 1776-2596
Elektronische ISSN: 1776-260X
DOI: https://doi.org/10.1007/s11523-021-00824-3

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Risk of Infection with Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis

Abstract

Background

Objectives

Patients and Methods

Results

Conclusions

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