Preexisting Rheumatoid Disease Not a Deterrent to Immune Checkpoint Inhibitor Therapy
Common rheumatologic autoimmune diseases in study participants included rheumatoid arthritis, polymyalgia rheumatic, and Sjogren syndrome.
Immune-related adverse effects following immune checkpoint inhibitor (ICI) therapy occur in a minority of patients with cancer and pre-existing rheumatic disease, according to findings published in Arthritis & Rheumatology.
Using medical records from the Mayo Clinic, investigators retrospectively obtained clinical data from patients with cancer and pre-existing rheumatic disease treated with ipilimumab, nivolumab, or pembrolizumab. A total of 16 patients were included in the final analysis (81% women; median age, 68.5 years). Patients had melanoma (n=10) or pulmonary (n=4) or hematologic (n=2) malignancies.
The most common rheumatologic autoimmune diseases in these patients included rheumatoid arthritis (n=5), polymyalgia rheumatica (n=5), systemic lupus erythematosus (n=2), and Sjogren syndrome (n=2). Glucocorticoids or immunosuppressive therapy was administered to 7 patients when an ICI was initiated and 15 patients with metastatic or stage IV cancer were receiving chemotherapy before receiving an ICI. Typically, ICIs were given following the failure of previous therapies.
A total of 6 patients experienced immune-related adverse effects; of note, they had longer survival compared with patients who did not experience these events (17 vs 1.4 months, respectively; P =.003). Survival differences remained significant when analyzing only patients with melanoma (P =.01). More patients with an immune-related adverse effects had melanoma compared with patients who did not experience an adverse effect during the study period (83% vs 50%; P =.31). Immune-related adverse effects were treated successfully with the use of corticosteroids and therapy discontinuation.
The study's limitations include its retrospective design and small patient cohort. The researchers also noted that the findings may lack generalizability since the cohort was limited to patients with advanced cancer.
Based on the findings that immune-related adverse effects and disease flares occur in a minority of patients with rheumatic disease, the investigators suggest “that routinely withholding ICI therapy in these patients is unfounded.”
Richter MD, Pinkston O, Kottschade LA, et al. Cancer immunotherapy in patients with preexisting rheumatic disease: the Mayo Clinic Experience [published online January 24, 2018]. Arthritis Rheumatol. doi:10.1002/art.40397