Use of immune checkpoint inhibitors in patients with solid tumors and pre-existing autoimmune or inflammatory disease: real-world data

• DOI: 10.2217/lmt-2021-0003
• Publication Date: 2021-07-02T11:25:35Z
• Authors: Virginia Calvo; Marta Andrés Fern...; Ana Collazo-Lorduy; Fernando Franco; Beatriz Núñez; Mariano Provencio
• Keywords: real-world data; risk–benefit; toxicity; 3. Good health; immune checkpoint inhibitors; flare-ups; 03 medical and health sciences; 0302 clinical medicine; cancer; immune-related adverse events; immunotherapy; discontinuation; Research Article

Abstract OBJECTIVE Immune checkpoint inhibitors (ICI) are a cornerstone in cancer treatment but they can induce immune-related adverse events (irAEs). Furthermore, patients with pre-existing autoimmune and/or inflammatory disease (AID) have been excluded from clinical trials. The objective of this study is to evaluate the efficacy and safety of ICI in patients with cancer and AID. METHODS This is an observational, retrospective study carried out at the Medical Oncology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid between January 2016 and December 2018. RESULTS 202 cancer patients treated with ICI were included, 15 (7, 4%) of them had pre-existing autoimmune diseases. The most frequent pre-existing AID were thyroid diseases (33.3%): autoimmune hypothyroidism, Graves Basedow disease and Hashimoto's thyroiditis. Three patients had psoriasis, two ANA + polyarthritis, one rheumatoid arthritis, another LADA (latent autoimmune diabetes in adults), another a systemic lupus erythematosus (SLE) and the last one, a polymyalgia rheumatica. In this series, the majority of patients (73.33%) did not experience any flare-up of their autoimmune disease. In patients who had AID flare-up, this was treated with corticosteroids. The most frequent cause of immunotherapy discontinuation was tumor progression (40%). 20% of patients had to discontinue immunotherapy due to toxicity. CONCLUSIONS In our series, AID flare or irAEs in patients with pre-existing AID who receive immunotherapy are not very common and can often be controlled without interrupting treatment. Prospective studies are needed to establish the incidence of irAEs in patients with preexisting autoimmune conditions, evaluate risk-benefits and elaborate management clinical guidelines in this population.