Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer

Abstract

Background: Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments. Patients and methods: The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted. Results: Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis. Conclusion: Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types.

Survival and risk of COVID-19 after SARS-COV-2 vaccination in a series of 2391 cancer patients

“…For the survival analyses, not all informations of comorbidities were collected, eg cardiovascular disease or diabetes. The CONSORE tool has limitations for the collection of information on follow-up and require manual verification when data are missing or inconsistent ( 32 ). As a descriptive real-life study, vaccinations were proposed and applied to patients at different time of the disease course, explaining heterogenous outcomes.…”

“…The information on vaccination and patient characteristics were collected from the electronic patient records (EPR) with the CONSORE tool as previously described ( 32 ), see also https://www.sword-group.com/en/news/projet-consore ). ConSoRe is a new data analytics solution aggregating diverse forms of structured and unstructured data extracted from EPR and structuring cancer management for all patients.…”

Second primary tumor after immune checkpoint inhibitor therapy: A case report

“… 5 However, the effect of ICIs on second primary tumors is not yet clear. Heudel et al concluded that ICIs could reduce the incidence of second primary tumors, 6 , 7 while Deng et al found an increased overall risk of second primary cancer after the introduction of ICIs to the treatment of melanoma. 8 In theory, the immune effect activated by ICIs is systemic and should be able to produce an offensive effect against all types of tumors.…”

A Case Series of Multiple Primary Malignancies Among Patients With Advanced Melanoma

“…While ICI are known to be efficacious against first primary tumors, their impact on second primary malignancies is not yet known. In a study by Heudel et al, patients treated with ICI for a first primary cancer had reduced risk of MPM, compared to those treated with chemotherapy [ 26 ]. In contrast, a SEER-based study comparing melanoma patients from the pre- and post-ICI eras (2005-2010 and 2011-2016, respectively), found that patients from the later period had more MPM [ 27 ]; however, the authors did not report whether patients received ICI or not (PD-1 inhibitors were approved in 2014), but rather looked at differences by date of treatment alone.…”