Up to One-Quarter of Patients With Lung Cancer Ineligible for Immunotherapy

Fourteen percent to 25% of patients with lung cancer also have autoimmune disease. This comorbidity could make them unsuitable candidates for immunotherapy, according to a recent study published in JAMA Oncology.1

Use of immunotherapy for the treatment of cancer is expanding, and clinical trials of immunotherapy typically exclude patients with autoimmune disease. In the United States, 20 million to 50 million people have an autoimmune disease.

"Our team wanted to determine if this practice had a significant impact. The new immunotherapy treatments also convey the risk of unpredictable, possibly severe, and potentially irreversible autoimmune toxicities affecting a variety of organs. With combination immunotherapy regimens, rates of these adverse events may exceed 50%," said  Saad Khan, MD, a member of the Simmons Cancer Center and assistant professor of internal medicine in the Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, and first author of this study.

In this study, data from 210 509 patients older than 65 years with lung cancer were examined by applying 2 different algorithms to measure the presence of autoimmune disease. The most common autoimmune diseases were psoriasis, polymyalgia rheumatica, and rheumatoid arthritis.

The relatively high rate of autoimmune disease among these patients with lung cancer could be due to advanced age and smoking history. Since patients with lung cancer are more likely to be older and have a history of smoking, these results should not be generalized to patients with other types of cancer.

Researchers hope the results from this study will influence the clinical practice and the design of clinical trials.

"Since the use of cancer immunotherapy is growing, examining the effectiveness and toxicity of these promising treatments among patients with autoimmune diseases will be critical," said David Gerber, MD, codirector of the UT Southwestern Experimental Therapeutics Program, associate professor of internal medicine, and codirector of the Lung Cancer Disease Oriented Team at the Simmons Cancer Center, and senior author of this study.

"While prior research has suggested that administering immune therapy to patients with autoimmune disease may be feasible, doing so carries the risk of making their disease worse, and requires careful monitoring."

Reference

1. Khan SA, Pruitt SL, Xuan L, Gerber DE. Prevalence of autoimmune disease among patients with lung cancer: implications for immunotherapy treatment options [published online June 4, 2016]. JAMA Oncol. doi:10.1001/jamaoncol.2016.2238.
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