Thursday, April 7, 2016

Anti-PD1 success in melanoma despite prexisting autoimmune disease, a case report:


In light of the very serious immune related side effects that are showing up in patients treated with immunotherapy, it would be pretty frightening to need such treatment knowing you already have an underlying autoimmune disease! (Although I took Opdivo knowing I have always had asthma and a family history positive for ankylosing spondylitis.)  On the other hand, it is now accepted that despite experiencing unfortunate immune related side effects when on ipi (for example) many patients go on to take anti-PD1 with no repeat of those problems and a positive response to melanoma can be attained....as was noted here:  Good news: melanoma patients who failed ipi had a response to nivo with no increased side effects
And here:  Nivo and pembro after failing ipi and vice versa


Successful Anti-PD-1 Antibody Treatment in a Metastatic Melanoma Patient With Known Severe Autoimmune Disease.  Maul LV1, Weichenthal M, K√§hler KC, Hauschild A.  J Immunother. 2016 Mar 28.

Pembrolizumab, an anti-programmed death-1 monoclonal antibody, has been approved by the Food and Drug Administration in 2014 on the basis of improved progression-free and overall survival in metastatic melanoma. We report for the first time a successful treatment with a programmed death-1 antibody in a 69-year-old metastastic melanoma patient with a Churg-Strauss lung vasculitis and a prior ipilimumab-induced autoimmune colitis. This case report suggests that pembrolizumab can be given with caution to patients with underlying autoimmune disease. As the use of checkpoint inhibitors expands, knowledge about their safety in patients with underlying autoimmune diseases will become increasingly important, in particular because these patients are typically excluded from clinical trials with immune-checkpoint inhibitors.

For what it's worth - c

3 comments:

  1. I was the 1st Autoimmune patient to take Yervoy back in 2013. I have a history of Systemic Lupus that has only affected skin and joints. During Ipi all the nodes in my neck swelled requiring 4 weeks of radiation due to concern of losing airway and I couldn't swallow. I also had mainly neurological side effects. About 1 month after Yervoy I started having severe Raynauds even though it was summer.
    I was diagnosed 6 mos ago with Autoimmune Thyroiditis which I think had been going on for quite a while and during the work up it was discovered I now have Scleroderma. The nodes in my neck were just T Cells not pseudo progression. Yervoy kept me stable but not NED and recently progressed and now on Nivo. It was a gamble but I am here right? A little worried when my Onc discovered a swollen node in my neck last week but just 1 so far. Just my experience!

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  2. I also meant to add that I was at risk for developing another autoimmune because I had Lupus. If you have 1 you are at high risk for another but the timing was suspect. I also developed Vitiligo in hair, neck, both knees. The presence of Raynauds 1 month after completing Yervoy most likely start of Scleroderma along with GI motility problems.

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  3. My goodness!! So sorry for all that you have been through!!! Autoimmune issues are not walk in the park...especially when complicated by needed treatment. I wish you well.

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