Further support for checkpoint inhibitor use in patients with rheumatic diseases
medwireNews: A single-center study adds support to the contention that immune checkpoint inhibitors need not be withheld from cancer patients with pre-existing rheumatic conditions.
Among 5200 patients with cancer who received ipilimumab, nivolumab, pembrolizumab, or a combination of these agents between 2011 and 2016, 16 had a confirmed diagnosis of a rheumatic disease, most commonly rheumatoid arthritis and polymyalgia rheumatica.
And of these, six (37.5%) patients experienced an immune-related adverse event (irAE), of which three were incidences of colitis and one a flare-up of the existing condition.
Lead author Uma Thanarajasingam (Mayo Clinic, Rochester, Minnesota, USA) and team report in Arthritis & Rheumatology that although four of the irAEs were of grade 3 or worse, all were managed successfully with corticosteroids and discontinuation of the checkpoint inhibitors.
Noting that the incidence of irAEs in the general population can be as high as 70–90%, they therefore believe that “routinely withholding [immune checkpoint inhibitor] therapy in these patients is unfounded.”
However, the study authors caution that “treatment decisions must factor in clinical judgement.”
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