Tolerability of immune checkpoint inhibitors in patients with cancer and pre-existing multiple sclerosis

Chavaz, Lara; Guyon, David; Boespflug, Amélie; Cauquil, Cécile; Michot, Jean‐Marie

doi:10.1016/j.ejca.2023.05.016

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…In the second, one patient of 11 (9%) experienced a relapse, but data on MRI activity were lacking. 14 Moreover, the median follow-up after ICI initiation was shorter (7.4 months [2–20]) than in our series and may have underestimated the risk of MS activity, which has been described between 2 weeks and 6 months. 4 , 5 , 7 …”

Section: Discussionmentioning

confidence: 56%

Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis

Androdias,

Noroy,

Psimaras

et al. 2024

Neurol Neuroimmunol Neuroinflamm

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Objectives Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment. Their mechanism of action raises the question of possible exacerbation of preexisting multiple sclerosis (MS). The aim of our study was to assess the risk of increased MS activity, defined by the occurrence of a relapse and/or a new MRI lesion, after ICI initiation. Methods This French multicentric study collected retrospective and prospective data on patients with MS treated with ICIs after a cancer diagnosis. Results We identified 18 patients with a median age of 48 years. Three of them (17%), all aged 50 years or younger, with a relapsing-remitting course, showed clinical and/or radiologic signs of MS activity 3 to 6 months after ICI initiation. They had stopped disease-modifying treatment (DMT) several months earlier, at the time of cancer diagnosis. Only one had both clinical and MRI activity, with mild severity and complete recovery. Discussion Our study suggests that the overall risk of MS activity under ICI is low and could be mainly driven by DMT discontinuation, as in MS in general. Although larger studies are needed for better risk assessment in younger patients with more active disease, ICI should be considered when needed in patients with MS.

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Section: Discussionmentioning

confidence: 56%

Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis

Androdias,

Noroy,

Psimaras

et al. 2024

Neurol Neuroimmunol Neuroinflamm

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“…In two recent series specifically examining outcomes in MS patients, one out of 27 patients in the two combined studies experienced a relapse, although notably, these were older patients with less inflammatory disease. 30 , 31 Larger, multi-center studies will be necessary to determine the true incidence of demyelinating exacerbations in this population, but these small single-center retrospective studies suggest that ICI-associated demyelinating exacerbations in people with pre-existing MS may be less common than exacerbations of pre-existing non-MS autoimmune diseases and that exacerbations in people with MS often respond well to standard treatment of relapses. Additionally, in both this study and prior studies, non-neurologic irAEs are more common than neurologic irAEs in both MS and non-MS populations treated with ICIs.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes after use of checkpoint inhibitor immunotherapies in people with multiple sclerosis

Nylander,

Rowles,

Poole

et al. 2024

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Immune checkpoint inhibitors (ICIs) represent a novel class of agents approved for the treatment of several cancers and progressive multifocal leukoencephalopathy (PML). However, due to the risk of autoimmune side effects, their use in people with autoimmune diseases such as multiple sclerosis (MS) has been limited. Objective To characterize outcomes in a cohort of adults with MS who received ICIs. Methods A single-center retrospective review of medical record data was performed for people with MS treated with ICIs. Results Seven people with MS were identified, with a mean (SD) age at ICI use of 55.4 (13.7) years and a mean MS duration of 18.2 (12.2) years. Six were treated for cancer; 1 was treated for PML. After mean (SD) follow-up of 1.76 (2.15) years after ICI, outcomes are: no evidence of disease (2), residual metastatic disease (1), death due to cancer (1), death due to PML (1), and lost to follow-up (2). Notably, 0 out of 7 patients experienced an MS relapse; two out of six had new asymptomatic demyelinating magnetic resonance imaging lesions. In the three patients with expanded disability status scale (EDSS) scores at baseline and follow-up, EDSS remained stable (mean delta 0.13). Conclusion In this cohort, no people with MS experienced clinical relapses and one-third experienced asymptomatic radiological activity following ICI treatment.

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“…A special population is represented by patients with multiple sclerosis. A retrospective analysis of 11 patients treated at the Gustave Roussy Institute showed that only 9% of patients had a flare of multiple sclerosis, while no data on correlation with efficacy exists [ 214 ].…”

Section: Third Line Predictive/prognostic Factorsmentioning

confidence: 99%

Predictive Factors in Metastatic Melanoma Treated with Immune Checkpoint Inhibitors: From Clinical Practice to Future Perspective

Poletto,

Paruzzo,

Nepote

et al. 2023

Cancers

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The introduction of immunotherapy revolutionized the treatment landscape in metastatic melanoma. Despite the impressive results associated with immune checkpoint inhibitors (ICIs), only a portion of patients obtain a response to this treatment. In this scenario, the research of predictive factors is fundamental to identify patients who may have a response and to exclude patients with a low possibility to respond. These factors can be host-associated, immune system activation-related, and tumor-related. Patient-related factors can vary from data obtained by medical history (performance status, age, sex, body mass index, concomitant medications, and comorbidities) to analysis of the gut microbiome from fecal samples. Tumor-related factors can reflect tumor burden (metastatic sites, lactate dehydrogenase, C-reactive protein, and circulating tumor DNA) or can derive from the analysis of tumor samples (driver mutations, tumor-infiltrating lymphocytes, and myeloid cells). Biomarkers evaluating the immune system activation, such as IFN-gamma gene expression profile and analysis of circulating immune cell subsets, have emerged in recent years as significantly correlated with response to ICIs. In this manuscript, we critically reviewed the most updated literature data on the landscape of predictive factors in metastatic melanoma treated with ICIs. We focus on the principal limits and potentiality of different methods, shedding light on the more promising biomarkers.

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Tolerability of immune checkpoint inhibitors in patients with cancer and pre-existing multiple sclerosis

Cited by 4 publications

References 5 publications

Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis

Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis

Clinical outcomes after use of checkpoint inhibitor immunotherapies in people with multiple sclerosis

Predictive Factors in Metastatic Melanoma Treated with Immune Checkpoint Inhibitors: From Clinical Practice to Future Perspective

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