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Review
. 2020 Apr;8(1):e000356.
doi: 10.1136/jitc-2019-000356.

Immunotherapy to treat malignancy in patients with pre-existing autoimmunity

Patrick Boland  1 , Anna C Pavlick  1 , Jeffrey Weber  1 , Sabina Sandigursky  2   3
Affiliations
Review

Immunotherapy to treat malignancy in patients with pre-existing autoimmunity

Patrick Boland et al. J Immunother Cancer. 2020 Apr.

Abstract

In the past 10 years, immune checkpoint inhibitors (ICIs) have become an additional pillar of cancer therapy by activating the immune system to treat a number of different malignancies. Many patients receiving ICIs develop immune-related adverse events (irAEs) that mimic some features of classical autoimmune diseases. Unfortunately, patients with underlying autoimmune conditions, many of whom have an increased risk for malignancy, have been excluded from clinical trials of ICIs due to a concern that they will have an increased risk of irAEs. Retrospective data from patients with autoimmune diseases and concomitant malignancy treated with ICIs are encouraging and suggest that ICIs may be tolerated safely in patients with specific autoimmune diseases, but there are no prospective data to guide management. In this manuscript, we review the relationship between pre-existing autoimmune disease and irAEs from checkpoint inhibitors. In addition, we assess the likelihood of autoimmune disease exacerbations in patients with pre-existing autoimmunity receiving ICI.

Keywords: autoimmunity; immunology; immunotherapy; oncology.

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Conflict of interest statement

Competing interests: JW consults for and has received less than US$10,000 dollars per annum from Merck, Genentech, Astra Zeneca, GSK, Novartis, Nektar, Medivation, Celldex, Incyte and EMD Serono and US$10-25,000 dollars from BMS for membership on Advisory Boards, holds equity in CytoMx, Biond and Altor, is on a scientific advisory board for Celldex, CytoMx, Incyte, Biond, Protean, CV6 and Sellas and was named on a patent from Moffitt Cancer Center on an ipilimumab biomarker and a PD-1 patent from Biodesix.

References

    1. Ladouceur A, Bernatsky S, Ramsey-Goldman R, et al. . Managing cancer risk in patients with systemic lupus erythematous. Expert Rev Clin Immunol 2018;14:793–802. 10.1080/1744666X.2018.1519394 - DOI - PubMed
    1. Simon TA, Thompson A, Gandhi KK, et al. . Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Res Ther 2015;17:212. 10.1186/s13075-015-0728-9 - DOI - PMC - PubMed
    1. Wang W, Macaulay W. Opioids vs Nonopioids for chronic back, hip, or knee pain. JAMA 2018;320:506–7. 10.1001/jama.2018.6945 - DOI - PubMed
    1. Khan SA, Pruitt SL, Xuan L, et al. . Prevalence of autoimmune disease among patients with lung cancer: implications for immunotherapy treatment options. JAMA Oncol 2016;2:1507–8. 10.1001/jamaoncol.2016.2238 - DOI - PMC - PubMed
    1. Kennedy LC, Bhatia S, Thompson JA, et al. . Preexisting autoimmune disease: implications for immune checkpoint inhibitor therapy in solid tumors. J Natl Compr Canc Netw 2019;17:750–7. 10.6004/jnccn.2019.7310 - DOI - PubMed