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Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study
Author(s) -
Tison Alice,
Quéré Gilles,
Misery Laurent,
FunckBrentano Elisa,
Danlos FrançoisXavier,
Routier Emilie,
Robert Caroline,
Loriot Yohann,
Lambotte Olivier,
Bonniaud Bertille,
Scalbert Camille,
Maanaoui Sarah,
Lesimple Thierry,
Martinez Stéphanie,
Marcq Marie,
Chouaid Christos,
Dubos Catherine,
BrunetPossenti Florence,
Stavris Chloé,
Chiche Laurent,
Beneton Nathalie,
Mansard Sandrine,
Guisier Florian,
Doubre Hélène,
Skowron François,
Aubin François,
Zehou Ouidad,
Roge Christophe,
Lambert Mickaël,
PhamLedard Anne,
BeylotBarry Marie,
Veillon Rémi,
Kramkimel Nora,
Giacchero Damien,
De Quatrebarbes Julie,
Michel Catherine,
Auliac JeanBernard,
Gonzales Gilles,
Decroisette Chantal,
Le Garff Gwenaelle,
Carpiuc Ioana,
Vallerand Hervé,
Nowak Emmanuel,
Cornec Divi,
Kostine Marie
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.41068
Subject(s) - medicine , discontinuation , autoimmune disease , cancer , adverse effect , psoriasis , cohort , disease , retrospective cohort study , rheumatoid arthritis , rheumatology , immunology
Objective Immune checkpoint inhibitors ( ICI s) for cancer therapy frequently induce immune‐related adverse effects ( IRAE s). Therefore, most patients with preexisting autoimmune diseases have been excluded from clinical trials of ICI s. This study was undertaken to evaluate the safety and efficacy of ICI s in patients with preexisting autoimmune disease and cancer. Methods A retrospective cohort study was conducted from January 2017 to January 2018 via 3 French national networks of experts in oncology and autoimmunity. Adults with preexisting autoimmune disease who were receiving ICI s were assessed for the occurrence of flare of preexisting autoimmune disease, other IRAE s, and cancer response. Results The study included 112 patients who were followed up for a median of 8 months. The most frequent preexisting autoimmune diseases were psoriasis (n = 31), rheumatoid arthritis (n = 20), and inflammatory bowel disease (n = 14). Twenty‐four patients (22%) were receiving immunosuppressive therapy at ICI initiation. Autoimmune disease flare and/or other IRAE (s) occurred in 79 patients (71%), including flare of preexisting autoimmune disease in 53 patients (47%) and/or other IRAE (s) in 47 patients (42%), with a need for immunosuppressive therapy in 48 patients (43%) and permanent discontinuation of ICI in 24 patients (21%). The median progression‐free survival was shorter in patients receiving immunosuppressive therapy at ICI initiation (3.8 months versus 12 months; P = 0.006), confirmed by multivariable analysis. The median progression‐free survival was shorter in patients who experienced a flare of preexisting autoimmune disease or other IRAE , with a trend toward better survival in the subgroup without immunosuppressant use or ICI discontinuation. Conclusion Our findings indicate that flares or IRAE s occur frequently but are mostly manageable without ICI discontinuation in patients with a preexisting autoimmune disease. Immunosuppressive therapy at baseline is associated with poorer outcomes.