Immune checkpoint inhibitors may induce flares in patients with pre-existing autoimmune disease

The initiation of immune checkpoint inhibitors (ICIs) for cancer in patients with pre-existing autoimmune disease appears to frequently lead to flares or immune-related adverse effects (IRAEs) that are mostly manageable, as shown in a study.

Researchers reviewed the medical records of 112 cancer patients with pre-existing autoimmune disease who were receiving ICIs. These patients were followed for a median of 8 months for the occurrence of flare, other IRAEs and cancer response.

Psoriasis was the most frequent pre-existing autoimmune disease (n=31), followed by rheumatoid arthritis (n=20) and inflammatory bowel disease (n=14). There were 24 patients (22 percent) on immunosuppressive therapy at ICI initiation.

A total of 79 patients (71 percent) developed autoimmune disease flare and/or other IRAE(s), including flare of pre-existing autoimmune disease in 53 (47 percent) and/or other IRAE(s) in 47 (42 percent), with a need for immunosuppressive therapy in 48 (43 percent) and permanent discontinuation of ICI in 24 (21 percent) patients.

On multivariable analysis, receipt of immunosuppressive therapy at ICI initiation was associated with shorter median progression-free survival (PFS; 3.8 months vs 12 months; p=0.006). Median PFS was also shorter in the presence of a flare of pre-existing autoimmune disease or other IRAE, with a trend toward better survival in patients without immunosuppressant use or ICI discontinuation.

“Although IRAEs are frequent and potentially severe, patients with pre-existing autoimmune disease are good candidates for ICI treatment,” according to the researchers, who recommended close follow-up and collaboration between oncologists and organ specialists in the management of this population.