Management and nursing strategies for different patterns of adverse events in patients with urological cancer treated with immune checkpoint inhibitors

Abstract

Background: This study aimed to explore the patterns of treatment-related adverse events (AEs) associated with immune checkpoint inhibitor (ICI) monotherapy and in combination with chemotherapy or tyrosine kinase inhibitor (TKI) therapy and to summarize the corresponding management and nursing strategies.

Materials and methods: A total of 69 patients with malignant urological tumors who received ICI treatment between June 2019 and October 2022 were retrospectively analyzed, and AEs that occurred during treatment were observed and reported. Based on the different types of treatment, the patients were divided into ICI monotherapy, ICI plus chemotherapy, and ICI plus TKI therapy groups. Subgroup analysis was performed. The incidence, distribution, and severity of AEs in the different subgroups were evaluated.

Results: A total of 138 AEs occurred in 69 patients, among which grade 1 plus 2, and grade 3 plus 4 AEs accounted for 78.99% and 21.01%, respectively. The incidence of AEs per patient in the ICI-TKI therapy group was the highest (3.75 times/person), followed by the ICI-chemotherapy (2.33 times/person) and ICI monotherapy (0.82 times/person) groups. Specific AEs, such as fatigue, nausea, and myelosuppression, were much more common in the ICI-gemcitabine and cisplatin group, whereas renal injury, skin lesions, and diarrhea were most common ones in the ICI-TKI group.

Conclusions: Immune checkpoint inhibitors are new treatment options for advanced urological tumors and renal cell carcinoma. Distinctive AE patterns were observed among the different treatment groups. Therefore, strict and meticulous clinical management and nursing measures are required to ensure the safety of patients receiving ICI treatment.

Keywords

Immune checkpoint inhibitor / Immunotherapy / Adverse events / Nursing / Urological tumor

Author summay

Xiaojuan Huang and Xiaolei Li contributed equally to this work and should be considered as co-first authors.

Supplemental Digital Content is available for this article.

Acknowledgments

None.

Statement of ethics

Ethical approval for the study was obtained from the ethnic committee of Peking University Third Hospital, with an approval number S2021259. Informed consent was obtained from all individual participants included in the study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

No conflict of interest has been declared by the authors.

Funding source

None.

Author contributions

XH: Conceptualization, methodology, data curation, visualization, data collection, writing - original draft;

XL: Formal analysis, validation, data collection, writing - review & editing;

LM: Project administration, supervision;

CL: Conceptualization, methodology, project administration, supervision.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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