Ipilimumab in metastatic melanoma patients with pre-existing autoimmune disorders

Abstract

This is the largest series of patients with pre-existing AD and treatment with ipilimumab reported. Flares of pre-existing AD were observed but manageable. Response rates and occurrence of new irAEs were comparable to previous trials. Thus, in this patient subgroup, ipilimumab can be a treatment option after a thorough discussion of pros and cons and taking severity and activity of the preexisting AD into account.

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“…2). This trend was also reported in other series . In Table 3 of our article, we presented the percentage of flares according to the 5 main preexisting autoimmune diseases in our cohort (84 of 112 patients [75%]), dominated by rheumatic disorders (rheumatoid arthritis, polymyalgia rheumatica/giant cell arteritis, spondyloarthritis).…”

“…For these reasons, we consider it more meaningful to classify the diseases according to the diagnosis, with a larger sample size, even if a classification by system might add clinical value. Interestingly, more flares were reported in the psoriasis group in our cohort, and 50% of patients with inflammatory bowel disease (IBD) experienced a flare, compared to lower flare frequencies reported in other retrospective cohorts . IBD represented a larger sample size in our cohort.…”

To treat or not to treat: Patient exclusion in immune oncology clinical trials due to preexisting autoimmune disease

“…The incidence of irAEs was higher in this study group than that reported in clinical trials. 23 Overall, these data suggest that ipilimumab is relatively safe and effective for patients with melanoma and preexisting AD as long as the treatment is accompanied by close monitoring for irAEs or exacerbation of AD symptoms. Only 25% of the patients (2 of 8) completed all 4 doses.…”

“…Response rates and irAE incidence rates were comparable to those of previous trials. 23 Overall, these data suggest that ipilimumab is relatively safe and effective for patients with melanoma and preexisting AD as long as the treatment is accompanied by close monitoring for irAEs or exacerbation of AD symptoms.…”

Enterocolitis due to immune checkpoint inhibitors: a systematic review

“…A second was a patient with UC and prior colectomy who developed diarrhoea and responded to treatment with infliximab 12. A third was a patient with UC who developed grade 3 colitis after two doses of ipilimumab and required treatment cessation and systemic steroids 13. An additional case report described a patient with UC and metastatic melanoma treated with ipilimumab who had a severe exacerbation of his colitis with perforation requiring total colectomy, but subsequently had complete response of his melanoma to ipilimumab 16.…”