Immune checkpoint inhibitors therapies in patients with cancer and preexisting autoimmune diseases: A meta-analysis of observational studies

Xie, Wenhui; Huang, Hong; Xiao, Shiyu; Fan, Yong; Deng, Xuerong; Zhang, Zhuoli

doi:10.1016/j.autrev.2020.102687

Cited by 46 publications

(32 citation statements)

References 20 publications

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“…The incidence of irAEs in the PAD group was 62.1%, which was similar to a previous pooled analysis (60%) that included PAD single-arm observational studies [5]. Therefore, we believe that the population of this study was relevant in evaluating the risk of irAEs.…”

Section: Discussionsupporting

confidence: 86%

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Preexisting autoimmune disease is a risk factor for immune-related adverse events: a meta-analysis

Yamaguchi

Saito

Okamoto

et al. 2021

Support Care Cancer

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Purpose Patients with preexisting autoimmune disease (PAD) are often excluded from clinical trials assessing immune checkpoint inhibitors (ICIs). Therefore, the safety of ICI therapy in patients with PAD remains unclear. Herein, we evaluated the incidence of immune-related adverse events (irAEs) in patients with PAD when compared with non-PAD patients.Methods We searched MEDLINE/PubMed, Web of Science, and Google Scholar for eligible studies from inception to January 2021. Observational studies reporting the incidence of irAEs in patients with and without PAD were included. We then performed a meta-analysis of eligible studies using forest plots. The primary endpoint of this study was the incidence rate of irAEs between patients with and without PAD.Results We identi ed three prospective and three retrospective studies involving 206 patients with PAD and 3078 patients without PAD. In the meta-analysis, 128 patients with PAD (62.1%) experienced irAEs, which occurred in 51.9% of non-PAD patients, resulting in an odds ratio (OR) of 2.14 (95% con dence interval [CI] 1.58-2.89). In the subgroup analysis, the incidence of irAEs was signi cantly higher in patients with PAD (OR = 2.19, 95% CI [1.55-3.08]). Furthermore, no signi cant heterogeneity or publication bias was detected, indicating that our meta-analysis could be generalized to clinical settings. ConclusionThis meta-analysis demonstrated that PAD was a risk factor for irAE incidence. These results suggest that monitoring the occurrence of irAEs in patients with PAD is required to manage irAEs appropriately.

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Section: Discussionsupporting

confidence: 86%

“…Hence, the e cacy and safety of ICIs in these patients remains unknown. Recently, a meta-analysis of observational studies assessing preexisting autoimmune disease (PAD) populations has reported that ICI treatments are effective and irAEs are often manageable [5].…”

Section: Introductionmentioning

confidence: 99%

Preexisting autoimmune disease is a risk factor for immune-related adverse events: a meta-analysis

Yamaguchi

Saito

Okamoto

et al. 2021

Support Care Cancer

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“…ICI therapy could exacerbate AIDs, and the presence of preexisting AIDs might be associated with a greater risk of developing new immune-related adverse events (irAEs), therefore close monitor-ing and multidisciplinary collaboration should be contemplated. 3 Although a systematic review suggested that flare-ups of AIDs and new irAEs were generally manageable with careful clinical follow-up and prompt therapy, they included few AIDs and irAEs associated with neurological disorders. 3 The incidence and prevalence of LEMS as a paraneoplastic neurologic syndrome in patients with SCLC is 3%.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although a systematic review suggested that flare-ups of AIDs and new irAEs were generally manageable with careful clinical follow-up and prompt therapy, they included few AIDs and irAEs associated with neurological disorders. 3 The incidence and prevalence of LEMS as a paraneoplastic neurologic syndrome in patients with SCLC is 3%. Tumor cells in SCLC have a neuroendocrine origin and express the same types of VGCCs as nerve terminals, therefore the immune system develops antibodies against these cancer proteins and misdirects against the nervous system.…”

Section: Discussionmentioning

confidence: 99%

An Extensive-stage Small-cell Lung Cancer Case With Preexisting Lambert-Eaton Myasthenic Syndrome Successfully Treated With an Immune Checkpoint Inhibitor

Sakaguchi

Kokubo

Furuhashi

et al. 2022

Clinical Lung Cancer

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Immune checkpoint inhibitor (ICI) therapy could exacerbate preexisting active autoimmune diseases (AIDs), and the presence of preexisting AIDs might be associated with a greater risk of developing new immunerelated adverse events (irAEs).• The safety of ICIs for patients with Lambert-Eaton myasthenic syndrome (LEMS), a neuromuscular autoimmune disease known as a paraneoplastic syndrome mainly associated with small-cell lung cancer (SCLC), is fully unknown.• We experienced an extensive-stage (ES)-SCLC patient with LEMS successfully treated with chemotherapy in combination with ICI without a flare-up of LEMS. • Phase III trials have shown that ICIs in combination with platinum doublet therapy significantly improved the overall survival of patients with ES-SCLC in first-line settings, therefore, patients diagnosed with ES-SCLC with the complication of LEMS have the widespread opportunity to receive ICIs as standard care. This report suggests that treatment using ICIs may be a treatment option to consider for ES-SCLC patients with LEMS.

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“…Based on the meta-analysis of observational studies and nationwide multicenter cohort study [5,6] , immune toxicities are frequent in ICI-treated patients with PAD but often mild and manageable without discontinuing therapy. It was concluded that ICI treatments are also effective in PAD patients although immunosuppressive therapies at baseline are associated with poorer outcomes.…”

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confidence: 99%

Effects of Immune Checkpoint Inhibitors on Cancer Patients with Pre-existing Autoimmune Disease

Furukawa

2021

Trends Immunother

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Immune checkpoint inhibitors therapies in patients with cancer and preexisting autoimmune diseases: A meta-analysis of observational studies

Cited by 46 publications

References 20 publications

Preexisting autoimmune disease is a risk factor for immune-related adverse events: a meta-analysis

Preexisting autoimmune disease is a risk factor for immune-related adverse events: a meta-analysis

An Extensive-stage Small-cell Lung Cancer Case With Preexisting Lambert-Eaton Myasthenic Syndrome Successfully Treated With an Immune Checkpoint Inhibitor

Effects of Immune Checkpoint Inhibitors on Cancer Patients with Pre-existing Autoimmune Disease

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