Safety and efficacy of PD-1 inhibitors in non–small cell lung cancer patients positive for antinuclear antibodies

Yoneshima, Yasuto; Tanaka, Kentaro; Shiraishi, Yuji; Hata, Kojiro; Watanabe, Hiroyuki; Harada, Taishi; Iwama, Eiji; Inoue, Hiroyuki; Masuda, Satohiro; Nakanishi, Yoichi

doi:10.1016/j.lungcan.2019.01.014

Cited by 51 publications

(51 citation statements)

References 18 publications

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“…Yoneshima et al analyzed if pretreatment positive antinuclear antibodies (ANA) are associated either with IrAE or treatment response after administration of PD-1 inhibitors (19). They analyzed a group of 83 patients, of which 18 had preexisting positive serum ANA at a titer of 1:40 or higher.…”

Section: Patients At Risk But Without Previous Clinical Evidence Of Amentioning

confidence: 99%

Efficacy and Toxicity of Immune -Checkpoint Inhibitors in Patients With Preexisting Autoimmune Disorders

et al. 2020

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Immunotherapy is an important armamentarium for cancer treatment nowadays. Apart from their significant effectiveness in controlling disease they also generate potential severe immune related adverse effects. Preexistence of immune related conditions may eventually predispose to the development of more severe complication and extreme caution have been taken in treating these patients. We performed a literature review searching for case reports and case series in order to offer evidence-based data for clinical management of these patients. Preexisting serological-only immune abnormalities or presence of a predisposing genetic background does not seem to confer significant risk but existing data is scarce. Most patients with preexistent autoimmune diseases can probably treated with checkpoint inhibitors as they seem to have at least the same response rate as the general cancer population. Under treatment, a significant part of them (at least 30%) can experience a flare of their baseline disease which can sometime be severe. Life-threatening cases seems rare and disease flare can be generally managed with steroids. The volume of available data is more important for rheumatologic diseases than for inflammatory bowel diseases were more caution should be observed. However, it has to be kept in mind that new immune related adverse effects (IrAE) are seen with a similar frequency as the flare of the baseline disease. Both flare-up's and newly developed IrAE are generally manageable with a careful clinical follow-up and prompt therapy.

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Section: Patients At Risk But Without Previous Clinical Evidence Of Amentioning

confidence: 99%

Efficacy and Toxicity of Immune -Checkpoint Inhibitors in Patients With Preexisting Autoimmune Disorders

et al. 2020

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“…However, the authors concluded that patients with preexisting autoimmune disease were more likely to develop immune-related adverse events and, as a result, receive corticosteroids. Yoneshima et al [ 22 ] examined the effects of PD-1 inhibitors on patients with preexisting ANA positive titers. There was no increase in the incidence of adverse events in this patient population compared to patients with negative ANA [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Yoneshima et al [ 22 ] examined the effects of PD-1 inhibitors on patients with preexisting ANA positive titers. There was no increase in the incidence of adverse events in this patient population compared to patients with negative ANA [ 22 ]. However, patients with rising ANA titers on therapy were found to have an increased incidence of grade 3-5 irAEs.…”

Section: Discussionmentioning

confidence: 99%

PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature

Ramos

Carmen

Yeku

2020

Case Reports in Oncological Medicine

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Background. Recurrent endometrial cancer after definitive therapy is a lethal disease. Recently, immune checkpoint inhibitors (ICI) have improved the management of mismatch repair-deficient (MSI-H) endometrial cancer. Autoimmune side effects are known to occur with ICI. As a result, patients with preexisting autoimmune diseases are excluded from studies involving these drugs. This has led to challenges in clinical practice regarding the use of ICI in otherwise eligible patients with underlying autoimmune disease. Case Presentation. We present the case of an 81-year-old woman with an underlying autoimmune vasculitis and recurrent, metastatic endometrial adenocarcinoma with microsatellite instability, who was treated with an immune checkpoint inhibitor. This patient received pembrolizumab, an immune checkpoint inhibitor that targets the programmed cell death-1 immune checkpoint. Ultimately, she was treated for 4 months with pembrolizumab and benefited from stable disease during this period. She remained asymptomatic from her underlying autoimmune P-ANCA vasculitis. A review of the scientific literature reveals several cases of the successful use of immune checkpoint inhibitors in patients with autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and inflammatory bowel disease. Conclusion. This is one of the first reports of a patient with an underlying autoimmune vasculitis successfully treated with an immune checkpoint inhibitor without exacerbating her underlying autoimmune condition. Carefully selected patients with underlying autoimmune vasculitis can be safely treated with ICI.

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“…[10][11][12] Previous data have reported contradictory results regarding the role of baseline autoimmunity in NSCLC patients treated with ICI and outcome, despite the fact that increased risk of ir-AEs has been correlated with better outcome. 4,5 In three of four current cohorts, outcome was similar for AID and non-AID patients, but patients with active AID had a shorter survival. 8,10,11 In the reported AID cohorts, between 20% and 56% of patients were symptomatic at the time of ICI initiation, and up to 20% were receiving immunosuppressant or immunomodulatory treatments for their AID.…”

mentioning

confidence: 89%

“…2 Immune dysregulation may be associated with heightened risk of immune-related adverse events (ir-AEs), especially among those patients with higher titers of autoimmunity. [3][4][5] AID cases are relevant in NSCLC because 14% of patients with NSCLC (especially females) have a concurrent AID, the most common ones being rheumatoid arthritis, psoriasis, and polymyalgia. 6 A history of AID in patients with NSCLC does not influence other treatment possibilities and is not associated with lung cancer-specific and all-cause mortality.…”

mentioning

confidence: 99%

Is There Room for Immune Checkpoint Inhibitors in Patients Who Have NSCLC With Autoimmune Diseases?

Remón

Hendriks

Aspeslagh³

et al. 2019

Journal of Thoracic Oncology

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Safety and efficacy of PD-1 inhibitors in non–small cell lung cancer patients positive for antinuclear antibodies

Cited by 51 publications

References 18 publications

Efficacy and Toxicity of Immune -Checkpoint Inhibitors in Patients With Preexisting Autoimmune Disorders

Efficacy and Toxicity of Immune -Checkpoint Inhibitors in Patients With Preexisting Autoimmune Disorders

PD-1 Inhibitor Therapy in a Patient with Preexisting P-ANCA Vasculitis: A Case Report and Review of the Literature

Is There Room for Immune Checkpoint Inhibitors in Patients Who Have NSCLC With Autoimmune Diseases?

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