Selected retrospective studies of PD-(L)1-targeted immune checkpoint blockers in patients with cancer and pre-existing autoimmune disease
| Menzies37 | Danlos33 | Leonardi36 | Cortellini32 | |
| Total no of patients | 119 | 397 | 56 | 751 |
| No of patients with pre-existing AID | 52* | 45† | 56 ‡‡ | 85‡ |
| Predominant cancer | Melanoma (100%) | Melanoma (80%), NSCLC (13%), others (7%) | NSCLC (100%) | NSCLC (66%), melanoma (21%), RCC (13%), others (<1%)§ |
| Pre-existing AIDs (n) | RA (13), sarcoidosis (3), PMR (3), SLE (2), scleroderma (2), PsA (2), SjS (2), PsO (6), eczema (1), EN (1), CD (3), UC (2), CelD (1), GBS (2), CIDP (1), MG (1), Bell’s palsy (1), GD (4), asthma (2), ITP (2) | Vitiligo (17), PsO (11), PsA (1), HT/GD (7), SjS (4), RA (2), ITP (1), SpA (1), MS (2), hidradenitis suppurativa (1), MG (1), PMR (1), PAN (1), sarcoidosis (1), CCL (1), T1D (1) | RA (11), PMR (5), SNRA (4), scleroderma (2), PsA (2), SLE (1), SjS (1), temporal arteritis (1), PsO (14), alopecia areata (1), discoid lupus (1), GD (5), HT (4), UC (3), CD (3), MG (1), MS (2), rheumatic fever (2), AIHA (1) | GD/AIT (54), PsO (13), vitiligo (2), lichen planus (1), PMR (2), SLE (2), RA (4), vasculitis (1), CD (3), PSC (1), autoimmune optic neuritis (1), MGN (1), GBS (1), MG (1), scleroderma (1) |
| Active/symptomatic AID | 15 (29%) | 30 (57%)¶ | 10 (18%) | 15 (18%) |
| AID treatment at ICB start | 20 (38%) | 7 (16%) | 11 (20%) | 15 (18%) |
| Any AID flare | 20 (38%) | 11 (24%) | 13 (23%) | 40 (47%) |
| High-grade (≥3) AID flare | 3 (6%) | NR | 2 (4%) | 8 (9%) |
| Median time to AID flare or irAE (months) | 1.2 (flare) | 2.1 (flare or irAE) | Range: 0.03–8.5 (flare) 1–17.5 (irAE) | 1.9–3.5 (grade 3/4 flare or irAE)** |
| Any irAE†† | 15 (29%) | 10 (22%) | 21 (38%) | 16 (19%) |
| High-grade (≥3) irAE†† | 5 (10%) | NR | 6 (11%) | 0 |
| Systemic IS for flare or irAE | Flare: 20 (38%) irAE: 7 (13%) | Flare/irAE: 6 (13%) | Flare: 4 (7%) irAE: 7 (13%) | NR |
| ICB interruption | Flare: 8 (15%) irAE: 3 (6%) | Flare/irAE: 1 (2%) | Flare: 2 (4%) irAE: 3 (5%) | NR |
| Permanent ICB discontinuation | Flare: 2 (4%) irAE: 4 (8%) | Flare/irAE: 4 (9%) | Flare: 0 irAE: 8 (14%) | Flare/irAE: 6 (7%) |
| Treatment-related deaths | 0 | 0 | 0 | NR |
| ORR | 33% | 38% | 22% | 38% (inactive AID), 50% (active AID) |
*Two patients had 2 concomitant AIDs.
†Eight patients had 2 concomitant AIDs.
‡Four patients had 2 concomitant AIDs.
§Percentages refer to the total cohort (n=751).
¶Percentage refers to 53 AIDs (8 patients had 2 concomitant AIDs).
**Median time to grade 3/4 irAE or flare was 1.9 months for inactive and 3.5 months for active AID.
††Excludes irAEs that were judged as AID flares.
‡‡Seven patients had more than 1 AID (6 had 2 AIDs, 1 had 3 AIDs).
§§
AID, autoimmune disease; AIHA, autoimmune hemolytic anaemia; AIT, autoimmune thyroiditis; CCL, chronic cutaneous lupus; CD, Crohn’s disease; CelD, coeliac disease; CIDP, chronic inflammatory demyelinating polyneuropathy; EN, erythema nodosum; GBS, Guillain-Barre syndrome; GD, Grave’s disease; HT, Hashimoto thyroiditis; ICB, immune checkpoint blocker; irAE, immune-related adverse event; IS, immunosuppression; ITP, immune thrombocytopenic purpura; MG, myasthenia gravis; MGN, membraneous glomerulonephritis; MS, multiple sclerosis; NR, not reported; NSCLC, non-small cell lung cancer; ORR, overall response rate; PAN, polyarteritis nodosa; PMR, polymyalgia rheumatica; PsA, psoriatic arthritis; PSC, primary sclerosing cholangitis; PsO, psoriasis; RA, rheumatoid arthritis; SjS, Sjogren’s syndrome; SLE, systemic lupus erythematosus; SNRA, seronegative RA; SpA, spondyloarthritis; T1D, type 1 diabetes.