American College of Rheumatology https://acrabstracts.org/abstract/risk-of-immunotherapy-related-toxicity-in-patients-with-rheumatoid-arthritis/

Patients with coexisting autoimmune disorders were generally excluded from checkpoint inhibitor (CPI) trials due to concerns over toxicity. A small cohort study suggests this patient group can safely receive CPI therapy.

Background

Immune checkpoint inhibitors (ICIs) have changed the therapeutic landscape in oncology leading to cures in some cancer types. However, patients with pre-existing autoimmune diseases (AIDs) were largely excluded from ICI trials due to concern for increased toxicity. In clinical practice some patients with rheumatoid arthritis (RA) have been treated with ICIs, but the risks of toxicity and/or disease flare have not been clearly outlined. Here we present data on the safety and efficacy of ICI therapy in patients with RA.

Conclusions

In our cohort, approximately half of the RA patients experienced flare and fewer had an irAE after initiation of ICI compared to a rate of 5-60% for any grade irAEs and 7-30% in severe irAEs in patients without autoimmune diseases depending on agent used. Most symptoms were manageable and a minority of patients required discontinuation of cancer-directed therapy. While this is a small cohort, the results of this analysis suggest that patients with RA experience severe irAEs at a rate similar to the population without autoimmune diseases. Further study is warranted to determine if ICIs may be offered to patients with RA as first line agents when used for an FDA approved indication. The choice of ICI and its effect on OS in this population also requires further prospective investigation.

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