Use of Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Autoimmune Disease

Abdel-Wahab, Noha; Shah, Mohsin; López-Olivo, María A.; Suarez‐Almazor, María E.

doi:10.7326/m17-2073

Cited by 386 publications

(254 citation statements)

References 68 publications

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“…A few other smaller case series have also reported on the frequency of disease flares and de novo IRAEs in patients with prior autoimmune disease receiving ICIs as treatment for concomitant cancer . Results have generally been similar to those reported by Tison et al, with approximately half of the patients developing a flare.…”

supporting

confidence: 75%

Is Immune Checkpoint Inhibitor Treatment an Option for Patients With Rheumatic Diseases and Cancer?

Buckley

Suarez‐Almazor

2019

Arthritis & Rheumatology

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supporting

confidence: 75%

Is Immune Checkpoint Inhibitor Treatment an Option for Patients With Rheumatic Diseases and Cancer?

Buckley

Suarez‐Almazor

2019

Arthritis & Rheumatology

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“…The authors concluded that clinicians should take the severity of a patient's underlying AD into account before they administer ICI therapy, and they should also monitor these patients very closely during treatment and after treatment discontinuation. 3 Moreover, the authors suggested that patients should be duly informed with respect to both the risks and benefits of ICI treatment.…”

Section: Icis and Patients With Ad (General)mentioning

confidence: 99%

“…1 Monoclonal antibodies that block these pathways allow the body to target cancer cells with fewer restraints. 3 Since 2011, the Food and Drug Administration has approved 6 checkpoint inhibitors for use in many different types of cancer (see Table 1). Anti-CTLA-4 antibodies block receptor activation and thereby allow resident T-cells to mount a more effective antitumor response.…”

Section: Introduction: Immune Checkpoint Inhibitorsmentioning

confidence: 99%

“…2 ICIs have dramatically increased survival for patients with certain types of cancers, and their therapeutic use is rapidly expanding. 3 Since 2011, the Food and Drug Administration has approved 6 checkpoint inhibitors for use in many different types of cancer (see Table 1). These agents demonstrate broad clinical activity and can induce durable disease control.…”

Section: Introduction: Immune Checkpoint Inhibitorsmentioning

confidence: 99%

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

Pantuck

McDermott

Drakaki

2019

Cancer

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Newly developed immune checkpoint inhibitors (ICIs) demonstrate impressive clinical activity. However, they can also cause life‐threatening side effects. The efficacy and toxicity associated with ICIs both derive from unregulated, enhanced immune activation. Health care providers have been hesitant to prescribe these medications to patients who have preexisting autoimmune disease (AD) because of concerns that this may exacerbate their underlying immune condition. These patients have also been excluded from ongoing ICI clinical trials. However, new data suggest that the potential benefits of ICI treatment may outweigh the potential risks for this patient group as long as physicians also provide sufficient monitoring for AD exacerbations or other side effects. Therefore, it may be appropriate to include patients with advanced malignancies and preexisting AD in ICI clinical trials when no other effective cancer treatment options exist. Overall, physicians should avoid excluding patients from ICI therapy unnecessarily when the potential benefits outweigh the potential risks.

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“…Therefore, most patients with preexisting inflammatory or autoimmune disease have been excluded from clinical trials of ICIs. Some case reports and small series, as well as a meta‐analysis assessing the use of ICIs in such populations, have been published recently, but more robust data on the safety of ICI therapy in larger cohorts of patients with preexisting autoimmune disease are needed . Whether the occurrence of IRAEs is associated with better antitumor response is a matter of debate .…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study

Tison

Quéré

Miséry

et al. 2019

Arthritis & Rheumatology

226

190

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Objective Immune checkpoint inhibitors (ICIs) for cancer therapy frequently induce immune‐related adverse effects (IRAEs). Therefore, most patients with preexisting autoimmune diseases have been excluded from clinical trials of ICIs. This study was undertaken to evaluate the safety and efficacy of ICIs in patients with preexisting autoimmune disease and cancer. Methods A retrospective cohort study was conducted from January 2017 to January 2018 via 3 French national networks of experts in oncology and autoimmunity. Adults with preexisting autoimmune disease who were receiving ICIs were assessed for the occurrence of flare of preexisting autoimmune disease, other IRAEs, and cancer response. Results The study included 112 patients who were followed up for a median of 8 months. The most frequent preexisting autoimmune diseases were psoriasis (n = 31), rheumatoid arthritis (n = 20), and inflammatory bowel disease (n = 14). Twenty‐four patients (22%) were receiving immunosuppressive therapy at ICI initiation. Autoimmune disease flare and/or other IRAE(s) occurred in 79 patients (71%), including flare of preexisting autoimmune disease in 53 patients (47%) and/or other IRAE(s) in 47 patients (42%), with a need for immunosuppressive therapy in 48 patients (43%) and permanent discontinuation of ICI in 24 patients (21%). The median progression‐free survival was shorter in patients receiving immunosuppressive therapy at ICI initiation (3.8 months versus 12 months; P = 0.006), confirmed by multivariable analysis. The median progression‐free survival was shorter in patients who experienced a flare of preexisting autoimmune disease or other IRAE, with a trend toward better survival in the subgroup without immunosuppressant use or ICI discontinuation. Conclusion Our findings indicate that flares or IRAEs occur frequently but are mostly manageable without ICI discontinuation in patients with a preexisting autoimmune disease. Immunosuppressive therapy at baseline is associated with poorer outcomes.

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Use of Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Autoimmune Disease

Abstract: National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Cited by 386 publications

References 68 publications

Is Immune Checkpoint Inhibitor Treatment an Option for Patients With Rheumatic Diseases and Cancer?

Is Immune Checkpoint Inhibitor Treatment an Option for Patients With Rheumatic Diseases and Cancer?

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

Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study

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