{
  "abstract": "Background Atopic diseases, which are characterized by IgE-mediated sensitization involving mast cells, basophils, and adaptive immune cells have an unclear role in cancer development and immune-related adverse events (irAEs). Atopy may heighten immune system surveillance and tumor elimination. Conversely, chronic immune activation may also promote oncogenesis via pro-inflammatory signaling and lead to T-cell exhaustion. We hypothesized that patients with atopy would have increased clinical benefit and increased toxicity to immune checkpoint inhibitors (ICI).Methods We conducted a retrospective analysis of patients in the Scripps Health System between 2017 and 2024. Eligible patients had a diagnosis of cancer (including melanoma, squamous cell carcinoma, basal cell carcinoma, Merkel cell carcinoma, lung adenocarcinoma, Hodgkin lymphoma, renal cell carcinoma, cholangiocarcinoma, cervical cancer, hepatocellular carcinoma, or bladder cancer), received an ICI, and carried a concurrent diagnosis of an atopic condition (atopic dermatitis, food allergy, or asthma) with allergist evaluation documented in the system.Results Interim data analysis included 289 patients with stage I (n=1), stage II (n=17), stage III (n=96), and stage IV (n=175) disease at initiation of ICI. 46 patients were on antihistamines or montelukast and 5 received dupilumab. PD-L1 expression was available for 17 patients with a median expression of 25%. Median follow-up from biopsy and ICI initiation was 2.2 and 1.6 years, respectively. Median ICI duration was 6 months. Best response on therapy included complete response (CR, n=107), partial response (n=61), stable disease (n=56), and disease progression (n=49) patients. Reasons for immunotherapy discontinuation include CR (n=74), disease progression (n=82), and toxicity (n=52). A total of 155 irAEs occurred among 132 patients (46%) including 43 (27.7%) events classified as grade 3 or 4. Most common irAEs include thyroid dysfunction (n=34, 12%), dermatitis (n=29, 10%), colitis (n=26, 9%), pneumonitis (n=25, 9%), and hepatitis (n=14, 5%). Corticosteroids were prescribed in 91 cases and tapered over a median of 8 weeks. Fifteen patients received a biologic (most commonly infliximab).Conclusions Published irAE incidence ranges from 80-85%% overall and 3–40% for grade ≥3 events depending on ICI class and whether combination regimens are used. 1 2 Our atopic cohort exhibited a higher rate of irAEs and severe toxicities, despite deriving similar therapeutic benefit. These findings underscore the need for further investigation into the immunobiology and optimal management of irAEs in patients with atopic disease.References Jayathilaka B, Mian F, Franchini F, Au-Yeung G, IJzerman M. Cancer and treatment specific incidence rates of immune-related adverse events induced by immune checkpoint inhibitors: a systematic review. Br J cancer 2025;132(1):51–7.Fujii T, Colen RR, Asim Bilen M, Hess KR, Hajjar J, Suarez-Almazor ME, et al. Incidence of immune-related adverse events and its association with treatment outcomes: the MD Anderson Cancer Center experience. Invest New Drugs 2017;36(4):638–46.",
  "authors": [
    {
      "affiliations": [
        "Scripps Health, La Jolla, CA, USA"
      ],
      "name": "Danielle Brazel"
    },
    {
      "affiliations": [
        "Scripps Cancer Center, La Jolla, CA, USA"
      ],
      "name": "Kathryn B Bollin"
    }
  ],
  "title": "1070 The interplay between atopy and immunotherapy: a retrospective analysis",
  "uid": "eec9b015-c27c-593e-837d-0c44a6c755f7"
}