ePoster Display session ePoster

31P - Safety and efficacy of immune checkpoint inhibitors in cancer patients with pre-existing autoimmune disease: A UK tertiary cancer centre experience (ID 281)

Presentation Number
31P
Lecture Time
09:41 - 09:41
Speakers
  • Grisma Patel (London, United Kingdom)
Session Name
ePoster Display session
Room
ePoster gallery
Date
Tue, 02.03.2021
Time
08:00 - 20:00
Authors
  • Grisma Patel (London, United Kingdom)
  • Paramvir Sawhney (London, United Kingdom)
  • Danielle Ohana (London, United Kingdom)
  • Michael Luong (London, United Kingdom)
  • Yien Ning Sophia Wong (London, United Kingdom)
  • Alvin J. Lee (London, Oxfordshire, United Kingdom)
  • Martin Forster (London, United Kingdom)

Abstract

Background

Immune check-point inhibitors (ICPi) are routinely used in cancer treatment in the United Kingdom and are associated with immune-related adverse events (irAE). Most patients with autoimmune disease (AID) are often excluded from clinical trials investigating ICPi, due to hypothetical increased risks of AID flare or severe irAE, but these risks have never been conclusively verified. We present experience using ICPi at a UK tertiary cancer centre, comparing the irAE profile and efficacy in patients with pre-existing AID to those without.

Methods

This was a single centre retrospective analysis of electronic records of solid tumour patients who received treatment with an ICPi from January 2017 to December 2020. From a total of 562 patients, 15 had pre-existing AID. These were compared to those without AID in a 1:3 matched cohort for tumour-type and treatment.

Results

The AID cohort had inflammatory bowel disease (N=5), psoriasis (N=3), rheumatoid arthritis (N=2), polymyalgia rheumatica (N=2), autoimmune endocrinopathies (N=4), lupus (N=1) and sarcoidosis (N=1). 3 patients had 2 co-existing AID. All 15 patients had well controlled AID. 9 were on hormone replacement, immunosuppressive (prednisolone <10mg, n=2, mesalazine, n=1), or topical agents. 6 were not on AID treatment. The table below lists patient demographics, irAE and outcomes. 3 out of 15 AID patients had irAE possibly linked to their underlying AID (1 psoriasis, 1 RA, 1 colitis; no G3 or higher). No significant differences were found in the number of G3 or higher irAE, treatment discontinuation due to irAE, response to treatment, or survival between cohorts.

Patient demographics, irAE and outcomes

No AID (n=45) AID (n=15) P-value
Tumour type 0.9698
Gynaecological 3 1
Colorectal 6 2
Head & neck 3 1
Merkel cell 3 1
Urothelial 6 2
Non-small cell lung 24 8
Immunotherapy agent >0.9999
Atezolizumab 3 1
Pembrolizumab 27 9
Durvalumab 3 1
Nivolumab 6 2
Ipilimumab and nivolumab 6 2
Treated under clinical trial 0.8686
Yes 13 4
No 32 11
Total number of irAEs 0.5691
0 21 9
1 17 5
2 7 1
Grade 3-5 irAEs 0.42
Grade 3 or 4 8 1
Grade 5 1 0
Best response 0.1044
Stable disease 5 1
Mixed response 5 1
Complete or partial response 18 5
Progressive disease 14 4

Conclusions

Exacerbation of pre-existing AID was infrequent and did not result in severe toxicity. Patients with well-controlled AID could be considered for entry in clinical trials involving ICPi.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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