Article Text

Download PDFPDF

1233 Impact of infections occurring in patients receiving immune checkpoint inhibitors for renal cell carcinoma (RCC)
  1. Catherine Wiechmann1,
  2. Kelly Gee1,
  3. Ethan Burns1,
  4. Jiaqiong Xu1,
  5. Yuqi Zhang1,
  6. Aubrey Crenshaw2,
  7. Abdullah Esmail1,
  8. Ryan Kieser1,
  9. Godsfavour Umoru3,
  10. Ibrahim Muhsen4,
  11. Kai Sun1,
  12. Zimu Gong1,
  13. Shivan Shah1,
  14. Monisha Singh1,
  15. Jun Zhang1,
  16. Eleni Efstathiou1 and
  17. Maen Abdelrahim1
  1. 1Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX, USA
  2. 2Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
  3. 3Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
  4. 4Baylor College of Medicine Section of Hematology and Oncology, Houston, TX, USA
  • Journal for ImmunoTherapy of Cancer (JITC) preprint. The copyright holder for this preprint are the authors/funders, who have granted JITC permission to display the preprint. All rights reserved. No reuse allowed without permission.


Background Immune checkpoint inhibitor (ICI)-based regimens including pembrolizumab/axitinib (P/A), nivolumab/cabozantinib (N/C), and nivolumab/ipilimumab (N/I) have improved outcomes in patients with RCC. While immune related adverse events are a well-known complication contributing to treatment delays, discontinuation, and morbidity, little is reported on the incidence and outcomes of infections. This study aims to assess the incidence, risk factors, and outcomes of infections occurring in patients with RCC receiving ICIs.

Methods Data was collected from 7 hospitals for patients who received P/A, N/C, or N/I for RCC from 1/2017–8/2021. Date of last follow-up was 12/2022. Covariates compared among infected and non-infected cohorts included age, gender, race, comorbidities, and ECOG. Risk factors for infection were assessed by univariable analysis with reported odds ratio (OR) and 95% confidence interval (CI). Outcome measures included all-cause emergency department (ED) visits, inpatient, and intensive care unit (ICU) admissions, median number of ICI cycles, progression free survival (PFS) and overall survival (OS). OS/PFS were evaluated using the Kaplan-Meier model. P-value <0.05 was considered statistically significant.

Results There were 149 patients included; 54 (36.24%), 34 (22.82%), and 61 (40.94%) received P/A, N/C, N/I, respectively. At least one infection was documented in 51 (34.2%) patients, of which 18 (35.29%), 12 (23.53%), 21 (41.18%) received P/A, N/C, N/I, respectively. There was no statistically significant difference in infectious risk between the three regimens. ECOG >1 (OR 6.22, [95% CI 1.92, 19.73], p=0.002) was associated with higher risk of developing infections. Infected patients had a higher rate of ED (14 (27.45%) vs 13 (13.27%), p= 0.033), inpatient (40 (78.43%) vs 42 (42.86%), p<0.001), and ICU admissions (13 (25.49%) vs 2 (2.04%), p< 0.001) than non-infected, and trended toward both a shorter PFS (7.27 [95% CI 4.97–16.43] vs 11.5 [95% CI 6.23–36.33], p=0.36) and OS (9.97 [95% CI 5.5–32.53] vs not reached, p=0.10), respectively. Infections did not impact number of cycles received compared to non-infected (5 [3–15] vs 4 [3–16], p=0.86). At last follow-up, there was a higher proportion of all-cause deaths in the infected vs non-infected cohort (28 [54.90%] vs (37 [37.76%], p=0.045); of these 17 (60.71%), 5 (17.86%), 5 (17.86%), and 1 (3.57%) died due to primary disease, infection, multiorgan failure, and ‘other’, respectively.

Conclusions Infections in patients receiving ICIs for metastatic RCC are common and the risk is similar across regimens. Infections are associated with a higher hospitalization rate, all-cause mortality, and trend toward poorer survival. Strategies to minimize infectious processes to optimize outcomes are needed.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.