Thursday, March 1, 2018

Tolerating immunotherapy for melanoma DESPITE prior diagnosis with rheumatologic disease

The fear by docs and patients alike, that those with a pre-existing autoimmune disease would experience an extreme flare of their disease should they take immunotherapy....which we know will stimulate the patient's immune response...seems quite reasonable!!!  BUT!  Thanks to some super brave ratties who went where others feared to tread....we have learned:

Patients with preexisting immune disease, melanoma, and treatment with Anti-PD-1? Yes, this can be done. Yes, autoimmune flares should be treated with immunosuppressive therapy while on immunotherapy. And YES!!!! These patients can still attain a response!

...a post with multiple links to prior reports within.  And, more recently....this:  Immunotherapy for melanoma with a pre-existing autoimmune disease??? YES!!! You can!

Now there's this:

Cancer immunotherapy in patients with preexisting rheumatologic disease: the Mayo Clinic experience. Richter, Pinkston, Kottschade, et al. Arthritis Rheumatol. 2018 Jan 24.

To determine the risk of rheumatologic disease flare and adverse effects in patients with preexisting rheumatologic disease receiving checkpoint inhibitor therapy.

A retrospective medical record review was performed to identify all patients who received checkpoint inhibitor therapy at Mayo Clinic, Rochester between 2011 and 2016 (approximately 5,200 patients). Those with preexisting rheumatologic disease were identified using specific diagnostic codes.

Sixteen patients were identified (81% female, median age 68.5). The most common rheumatologic diseases were rheumatoid arthritis (5), polymyalgia rheumatica (5), Sjogren's syndrome (2), and systemic lupus erythematosus (2). Seven patients were receiving immunosuppressive therapy or glucocorticoids for their rheumatologic disease upon initiation of a checkpoint inhibitor. The primary malignancies were melanoma (10), pulmonary (4), or hematologic (2). In most cases checkpoint inhibitors were offered only after failure of several other therapies. Immune-related adverse effects (IRAE) occurred in 6 patients and all were treated successfully with corticosteroids and discontinuation of therapy. There were no significant differences in time from cancer diagnosis to immunotherapy, duration of immunotherapy, age, or sex between the patients with and without IRAEs.

To our knowledge, this represents the largest single-center cohort of patients with rheumatologic diseases who were exposed to modern cancer immunotherapy. Only a minority of these patients experienced a flare of their preexisting rheumatologic disease or any other IRAE. 

In these 16 patients with preexisting autoimmune disease there were some immune-related side effects.  However, just like melanoma peeps who have unfortunate immune related side effects thought they do NOT have a preexisting rheumatologic disease, these adverse events were handled with corticosteroids and break in therapy.  

Hang tough peeps!  Hang tough! - c

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