Use of immune checkpoint inhibitors in patients with solid tumors and pre-existing autoimmune or inflammatory disease: real-world data

Juan, V. Calvo de; Fernández, Marta Andrés; Collazo-Lorduy, Ana; Franco, Fernando; Núñez, Beatriz; Provencio, Mariano

doi:10.2217/lmt-2021-0003

Cited by 11 publications

(11 citation statements)

References 28 publications

(3 reference statements)

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“…Finally, 12 studies (11-22) met the eligibility criteria, and the selection flowchart is shown in Figure 1. All studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) were published in English. The publication dates ranged from 2016 to 2021.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Two studies (15,18) were prospective. Eleven studies (11)(12)(13)(14)(16)(17)(18)(19)(20)(21)(22) were multicenter, and the majority of these studies were conducted in the United States, Australia, France, Germany, and Spain. A total of 191 participants were included, with four studies (11,18,19,21) including patients with psoriasis, whereas the remaining eight studies (12-17, 20, 22) included patients with psoriasis and PsA.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…One study (20) targeted psoriatic patients only, whereas 11 studies (11-19, 21, 22) included participants with cancer and any AIDs. Five studies (11)(12)(13)(14)19) included patients with melanoma, two studies (16,22) included patients with non-small cell cancer (NSCLC), one study (18) focused on urologic cancer, and the remaining (11-15, 17, 19-21) were mixed. The classes of ICIs included the following: anti-PD-1 (12,13,15,17,22), anti-PD-L1 (17,18) anti-CTLA-4 (11,14), and combination (16,(19)(20)(21).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Five studies (11)(12)(13)(14)19) included patients with melanoma, two studies (16,22) included patients with non-small cell cancer (NSCLC), one study (18) focused on urologic cancer, and the remaining (11-15, 17, 19-21) were mixed. The classes of ICIs included the following: anti-PD-1 (12,13,15,17,22), anti-PD-L1 (17,18) anti-CTLA-4 (11,14), and combination (16,(19)(20)(21). All of these studies have reported the safety and efficacy of ICI therapy.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…A flare was defined as a recurrent or worsening of prior psoriasis syndrome, which was reported in all 12 studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), involving 191 participants. The pooled meta-analysis showed that the incidence of flares was 45.0% (95% CI: 31.1%-58.9%) based on a random-effects model with significant heterogeneity (I 2 = 71.7%, p < 0.001; Figure 2A).…”

Section: Psoriasis Flare Clinical Manifestation and Managementmentioning

confidence: 99%

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Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies

Zhou

Zhang

et al. 2022

Front. Oncol.

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BackgroundImmunotherapies represented by immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. A large part of the population has both cancer and psoriasis but is usually excluded from ICI clinical trials because of the dysregulated activation of the immune system. This is the first study to evaluate the safety and efficacy of ICI therapy in patients with cancer and preexisting psoriasis.MethodsPubMed, EMBASE, Cochrane, and MEDLINE databases were searched from inception through February 2022. Observational studies on patients with cancer and confirmed psoriasis before ICI initiation were included. Outcomes included the incidence of psoriasis flares, de novo immune-related adverse events (irAEs), discontinuation rate due to flare/de novo irAEs, and efficacy of ICI therapy. Clinical manifestations, management, and outcomes for adverse events (AEs) were systematically reviewed. All pooled analyses were based on a random-effects model using Stata software. Meta-regression and subgroup analyses were performed to identify sources of heterogeneity.ResultsTwelve studies involving 191 patients were included. The pooled incidence of psoriasis flares was 45.0% (95% CI: 31.1%-58.9%, I2 = 71.7%) and 44.9% (95% CI: 29.0%–60.7%, I2 = 71.8%) for de novo irAEs. The tumor type, psoriasis subtype, ICI class, and country were the main sources of heterogeneity. Grade 3–4 flares occurred in 10.8% (95% CI: 5.3%–16.3%) of patients, and about 16.6% (95% CI: 10.7%–22.5%) of patients experienced grade 3–4 de novo irAEs. The estimated incidence of ICI discontinuation due to AE was 18.5% (95% CI: 6.1%–30.8%, I2 = 68.7%). The median times to develop flare and de novo irAEs were 44 and 63 days, respectively. Endocrinopathies and colitis were the most common de novo irAEs. Conventional therapy is effective for most AEs. The estimated objective response rate (ORR) of ICIs was 38.1% (95% CI: 11.8%–64.3%, I2 = 81.7%), and the disease control rate (DCR) was 64.5% (95% CI: 55.3%–73.8%, I2 = 0).ConclusionsThe flare of patients with cancer and preexisting psoriasis treated with ICI therapy is frequent, but the incidence of de novo irAEs and the efficacy of ICI therapy are comparable to those of the general population. Most AEs are mild and manageable with conventional therapy, which required discontinuation of ICI therapy in 18.5%.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022320646

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