# Incidence Rates of Cutaneous Immune-Related Adverse Events in Patients with Lung Cancer: A Systematic Review and Meta-Analysis

## TL;DR

This study finds that about 20% of lung cancer patients experience skin-related side effects from immune therapy, with higher rates in those on combined treatments.

## Contribution

The study provides the first comprehensive meta-analysis of cirAE incidence in lung cancer patients treated with ICIs.

## Key findings

- The pooled incidence of cirAEs in lung cancer patients is 20.26%.
- Subgroup analyses show significant variation in cirAE rates based on treatment type and diagnostic criteria.
- Combined or dual ICI therapies are associated with higher cirAE incidence.

## Abstract

Objective: Cutaneous immune-related adverse events (cirAEs) represent a prevalent manifestation of adverse reactions linked to immune checkpoint inhibitors (ICIs) therapy, substantially affecting patients’ quality of life. This systematic review and meta-analysis aimed to quantify the pooled incidence of cirAEs in this population and strengthen clinical awareness for early recognition and management. Methods: A comprehensive search of PubMed, Embase, CINAHL, Cochrane Library, CBM, CNKI, and Wanfang databases was conducted from inception to December 2022. Literature that reported the incidence of cirAEs in patients with lung cancer receiving ICIs therapy was included. A meta-analysis was conducted using R software, version 4.4.1 to estimate the pooled incidence of cirAEs, and a random-effects model was used for data synthesis. Begg’s rank correlation and funnel plots were used to assess publication bias. Results: A total of 99 articles involving 23,814 patients with lung cancer receiving ICIs therapy were included, with publication dates ranging from 2012 to 2022. The meta-analysis results reveal that the incidence of cirAEs in patients with lung cancer was 20.26% (95% confidence interval [CI (17.12–23.81)]. Significant differences were observed between all subgroups, including continent, study type, combination therapy, dual ICIs therapy, and diagnostic criteria for cirAEs for Grade 1–2 and Grade 3–4 incidences. Conclusions: The incidence of cirAEs in patients with lung cancer is relatively high, particularly undergoing combined or dual ICIs therapy. To comprehensively characterize cirAEs in patients with lung cancer, large-scale multicenter studies integrating real-world pharmacovigilance data are warranted to establish precise incidence estimates and identify clinically significant risk factors. Implications for clinical practice: This review’s insights aroused clinical staff’s attention and concern about cirAEs, potentially enhancing the quality of life of patients with cancer.