Feb 8, 2020

Most Patients With Cancer With Autoimmune Diseases Can Safely Receive Immunotherapy

By Ed Susman

ORLANDO, Fla -- February 8, 2020 -- Although patients with advanced cancer with a history of autoimmune diseases are often excluded from immunotherapy clinical trials, many can safely take immune checkpoint inhibitors, according to a study presented here at the 2020 Clinical Immuno-Oncology Symposium.

In a retrospective study of 39 patients diagnosed with stage IV cancer who also had a history of autoimmune disease, 8 experienced a flare of their autoimmune disease and 9 experienced immunotherapy-related adverse events while under treatment, reported Karine Tawagi, MD, Ochsner Clinic, New Orleans, Louisiana.

“Patients with a history of autoimmune disorders were generally excluded from immune checkpoint inhibitor trials due to concerns that these individuals might be at great risk for developing serious immune-mediated adverse events or worsening of their pre-existing autoimmune disorders,” said Dr. Tawagi. “But oftentimes, treatment with checkpoint inhibitors is the best choice of treatment for these patients and can result in fewer toxicities than traditional chemotherapies. So, at the physician’s discretion, some of these patients are treated with immunotherapy.”

In the retrospective study, 44% of the 39 patients who were treated with the checkpoint inhibitors had active autoimmune disease at the time they began treatment for lung cancer (n = 21) genitourinary cancers (n = 8), melanoma (n = 4), or other cancers (n = 6).

Interestingly, patients who had flares or had immune-mediated adverse events had a higher response rate to immunotherapy. About 43% of the patients with a flare or adverse event achieved an objective response compared with 12% of the patients who did not experience a flare (P = .0475). The flare-up may be an indication that the treatment was, in fact, having an impact on the disease.

“There seems to be a potential increase in the odds of response among patients presenting flare,” said Dr. Tawagi. “However, the confidence interval is wide. Corroboration at other centres is needed and larger sample size may help clarify this potential association.”

Among the patients who had a flare-up, 5 had pre-existing rheumatoid arthritis, 2 had inflammatory bowel disease, and 1 patient had psoriasis. The immune-mediated adverse events included 3 cases of pneumonitis, 2 dermatitis cases, and 1e case each of thyroiditis, pancreatitis, colitis, and alopecia.

“Patients with autoimmune disorders should be considered for immune checkpoint inhibitor therapy if this is the best course of treatment recommended,” said Dr. Tawagi. “The toxicities, if they occur, are generally manageable and can be treated if they do occur.”

The 2020 Clinical Immuno-Oncology Symposium is co-sponsored by the American Society of Clinical Oncology (ASCO) and the Society for Immunotherapy of Cancer (SITC).

[Presentation title: Immune Checkpoint Inhibitor Use in Cancer Patients With a Pre-Existing History of Autoimmune Disorders. Abstract 100]

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