Tuesday, 23 Apr 2019

You are here

Cancer Therapies Inducing Immune-Related Adverse Events (irAEs)

Recent shifts in the cancer treatment paradigm towards immune therapies has led to wide implementation of the novel immune check point inhibitors (ICI) in the treatment of multiple types of advanced cancer.

While being quite effective in oncology, these checkpoint inhibitors have led to the emergence of a quite unique spectrum of rheumatologic conditions presented under the umbrella of immune-related adverse events (irAEs).

A single-center prospective observational study was designed to evaluate and characterize irAEs and patients on ICI and to assess for association with treatment response and patient survival.

Out of 636 patients treated with PD-1, PD-L1 and CTLA-4 for predominantly melanoma, NSCLC and renal carcinoma 43% experienced irAEs. Dermatological manifestations, along with GI, endocrine and rheumatic were amongst the most common irAEs.

65% of tumor treatment responders along with 56% of stable patients experienced at least one irAE comparing to 24% in non-responder group.

Most irAEs were observed in patients receiving sequencial (68%) and combined (65.6%) ICI therapy. Significantly better survival rates were observed in patient who experienced at least one irAE with median survival of 1169 days vs 24 days, p <0.000. no difference was observed in regards to organ system manifestations.

In summary, irAEs in cancer therapies showed to be strongly associated with overall survival and better tumorous response. Authors suggest multidisciplinary approach, including rheumatologist on as needed basis to maintain full benefit if ICI treatments.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Update on Vaccines in Autoimmune Patients

Although both the disease and the treatment for it in rheumatology patients may work at cross-purposes with immunizations, only a very few vaccines are absolutely contraindicated in this population, an infectious disease specialist told rheumatologists here.

RheumNowLive On Demand: Infection Prevention and Management with Newer Agents - Jack Cush, MD

A clip from RheumNow Live On Demand. You can access the full library of content from the meeting.

Acute Problems Associated With Cannabis Use

An observational study published in Annals of Internal Medicine finds that emergency department (ED) visits attributable to inhaled cannabis are more frequent than those attributable to edible cannabis, although the latter is associated with more acute psychiatric visits and more ED visits than expected.

Best of 2018: The Safety of Paternal Exposure to DMARDs and Biologics

Pregnancy and drug safety is a complex issue, often with limited information about maternal drug exposure on the offspring. Greater uncertainty exists when considering whether paternal exposure may also influence fetal outcomes.

A systematic review examined the effect of disease modifying anti-rheumatic drugs (DMARDs) on male fertility and if peri-conception (within 3 months) paternal exposure was detrimental to fetal outcomes.

Best of 2018: Hydroxychloroquine Being Over-Dosed with New Guidelines?

Hydroxychloroquine retinopathy prevention guidelines have revised from ideal body weight-based dosing to actual body weight-based dosing; the question remains whether these have been adopted in clinical practice. A database of nearly 21,000 new HCQ users from a UK general population database studied HCQ dosing and use between 2007 and 2016. Specifically they examined whether users were subjected to excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW).