Preexisting Autoimmune Disease: Implications for Immune Checkpoint Inhibitor Therapy in Solid Tumors

Abstract

The use of immune checkpoint inhibitors (ICIs) is rapidly expanding to the treatment of many cancer types, both in the metastatic setting and as an adjuvant to other therapies. Clinical trials using ICIs have largely excluded patients with preexisting autoimmune diseases due to concerns for increased toxicity. However, emerging evidence shows that ICIs may be considered in some patients with autoimmunity. This review discusses the commonalities between clinical autoimmune diseases and ICI-induced immunotherapy-related adverse events, and summarizes the existing case series that describes patients with solid tumors who have a preexisting autoimmune disease. This review also discusses which patients with autoimmunity could be considered reasonable candidates for ICI therapy.

Severe Neurological Toxicity of Immune Checkpoint Inhibitors: Growing Spectrum

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Immune checkpoint inhibitor nephrotoxicity: what do we know and what should we do?

“…A review of 8 case series using PD-1/PD-L1 inhibitors (n ¼ 6) or ipilimumab (n ¼ 2) included 337 patients with well-controlled autoimmune disease treated with immune checkpoint inhibitors who were examined for disease flares and unrelated IrAEs. 96 Sixteen percent to 44% of patients were taking immunosuppressive agents (87.5% in 1 series) before drug therapy. Flare of autoimmune disease ranged from 6% to 75% in the case series, while unrelated IrAEs occurred in 16% to 50%.…”

Immunotherapy to treat malignancy in patients with pre-existing autoimmunity

“…Data from studies of patients with concomitant diagnoses of cancer and autoimmunity suggest that tens of thousands of patients might be excluded from treatment with ICIs even if they might provide clinical benefit due to a concern for exacerbation of an autoimmune condition. 5 This led to a re-examination of the omission of patients with pre-existing autoimmunity from trials of ICIs, and to reassess guidelines for ICI treatment that recommend that those patients not be treated with ICI. In 2020, AID is not an absolute contraindication for the use of ICIs; however, many oncologists are still wary of using ICIs in this patient population as the exact risks remain unclear.…”