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No immune-related adverse events found in 40% of patients who received immune checkpoint inhibitors
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WASHINGTON — Despite most patients having an autoimmune disease at the time of checkpoint inhibition, no immune-related adverse events or disease exacerbation were found in 40% of patients who received immune checkpoint inhibitors, according to a systematic review of case reports presented at the American College of Rheumatology Annual Meeting.
Noha Abdel-Wahab, MD, PhD, in the Department of General Internal Medicine at the University of Texas MD Anderson Cancer Center, and colleagues performed a systematic review of 14 reports that described a total of 45 cases of patients with cancer and autoimmune disease diagnosed before initiation of checkpoint inhibitor therapy. The researchers collected information on patient characteristics, checkpoint inhibitor type, immune-related adverse events (IRAEs), overall management, clinical outcome and whether treatment re-challenge was reported.
Of the 45 cases, 86.8% had concomitant treatment — including corticosteroids, disease-modifying antirheumatic drugs and biologics — for their autoimmune disease (AID). Slightly more than half of patients (53.9%) still had an AID at the time of checkpoint inhibitor therapy, 88.9% of which was ipilimumab. After receiving therapy, 40% of patients reported de novo IRAEs; 28.9% reported exacerbation of a pre-existing AID; 8.9% reported both; and 40% did not report any adverse events. Also, 27.8% of patients had hypophysitis and a separate, but not mutually exclusive, 27.8% of patients had colitis with de novo IRAEs. Physicians recommended discontinuation of therapy in 33.3% of cases and IRAE resolution occurred in most patients.
There was one death by toxic epidermal necrolysis and another from severe colitis. There was also one case of treatment re-challenge in a patient with ulcerative colitis who developed exacerbation after ipilimumab use. After re-challenge, the patient reported grade 3 anterior panhypopitutarism and tracheobronchitis. More studies are needed to establish the efficacy of ipilimumab, the researchers wrote.
Reference:
Abdel-Wahab N, et al. Abstract #1342. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.
Disclosure: The researchers report no relevant financial disclosures.