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Comment & Response
August 12, 2021

Association of Adjuvant Immunotherapy Duration With Chronic Immune-Related Adverse Events

Author Affiliations
  • 1Cancer Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
JAMA Oncol. 2021;7(10):1573-1574. doi:10.1001/jamaoncol.2021.2954

To the Editor Immune checkpoint inhibitors (ICIs) have transformed the prognosis of patients with melanomas over the past decade. One year of adjuvant treatment with anti–programmed cell death 1 has been shown to improve the survival of patients with high-risk stage III melanomas. The corresponding pivotal trials have described the occurrence of immune-related adverse events (irAE) that occurred (4% any grade and 1% grade 3-4) or persisted (21% grade 3-4) after ICI discontinuation.1,2 In their recent multicenter cohort study published in JAMA Oncology, Patrinely et al3 reported that 43.2% of patients with high-risk melanoma receiving adjuvant ICI therapy experienced chronic irAEs, and approximately one-third required steroid therapy, combined, in some cases, with persistent immunosuppression. At the last follow-up, 85.6% still experienced irAEs, such as endocrinopathies, arthritis, xerostomias, neurotoxic effects, and ocular events, that were likely to become chronic disorders.3 Although these findings should be interpreted with caution given the critical challenges in assessing irAEs,4 we concur with the conclusion of the authors3 to integrate the risks of chronic irAEs into treatment decision-making. More importantly, these findings call into question the optimal duration of adjuvant ICI therapy that limits the occurrence of chronic irAEs without compromising the survival outcomes.

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