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L. Misery
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P2.07 - Immunology and Immunotherapy (ID 708)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.07-023 - Safety of Immune Checkpoint Inhibitors in Patients with Preexisting Autoimmune Disease (ID 8646)
09:30 - 09:30 | Author(s): L. Misery
- Abstract
Background:
Immune checkpoint inhibitors (ICIs), by inhibiting immunosuppressive molecules overexpressed in the tumoral environment like CTLA-4 or PD1, increase the anti-tumor immune response and have been approved for an increasing number of cancers. However, they are responsible for immune related adverse effects (IRAEs), and patients with preexisting autoimmune diseases (PAD) have been excluded from clinical trials evaluating those molecules. The aim of this study was to evaluate their safety in routine practice in patients with PAD and the anti-tumoral response in this population.
Method:
Three national expert networks, focusing respectively on skin cancers, thoracic cancers, and inflammatory diseases, participated in the study. All patients who received an ICI despite a PAD were retrospectively included in this nationwide retrospective study.
Result:
31 patients were included in the study (19 men (61%), median age of 66). Most frequent PADs were rheumatoid arthritis (n=9; 29%), psoriasis (n=6; 19%), lupus (n=4; 13%), ulcerative colitis (n=3; 10%), and spondyloarthritis (n=3; 10%). Eleven patients were receiving an immunosuppressive therapy when the ICI was initiated, and 10 had an active disease at that time. Neoplasm types were melanoma (n=16; 52%), non-small-cell lung carcinoma (n=12; 39%), and urologic neoplasms (n=3; 9%), with a median disease duration of 19 months. The majority of the patients (30/31) received an anti-PD1 drug, for a median duration of 4 months. PAD flares were frequent (n=18; 58%) but mostly mild: CTCAE grade 1-2 (n=12; 67%), grade 3-4 (n=3; 17%). 14 patients (78%) received corticosteroids or NSAIDs, and 3 (17%) methotrexate or acitretine for the treatment of these flares. IRAEs not associated with PAD appeared in 10 patients (32%): arthralgia (n=5), colitis (n=2), thyroiditis (n=2), vitiligo (n=2) with mild severity. None of the patients received TNF blockers, neither for a flare nor for an IRAE. 5 patients discontinued the immunotherapy because of an adverse effect. Regarding the cancer response rate, 4 patients over 11 who were taking an immunosuppressive treatment were responders (36%), versus 12 over the 20 other patients (60%).
Conclusion:
PAD flares are frequent during ICI therapy and other IRAEs are also possible, usually easily managed with corticosteroids only. Anti-tumor response could be reduced when an immunosuppressor is ongoing at the beginning of the ICI, within the limit of the number of patients already so far. Overall, the tolerance of ICIs in patients with PAD seems acceptable, but a multidisciplinary follow-up with the PAD referral physician is appropriate to manage frequent PAD flares and/or IRAEs.
