Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: review of the literature and personalized risk-based prevention strategy.
- Haanen J Netherlands Cancer Institute, Division of Medical Oncology, Amsterdam, The Netherlands.
- Ernstoff MS Roswell Park Comprehensive Cancer Center, Buffalo, USA.
- Wang Y Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, Houston, USA.
- Menzies AM Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia.
- Puzanov I Roswell Park Comprehensive Cancer Center, Buffalo, USA.
- Grivas P University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, USA.
- Larkin J Royal Marsden NHS Foundation Trust, London, UK.
- Peters S Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV) and Lausanne University, Lausanne, Switzerland.
- Thompson JA University of Washington, Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, USA; National Cancer Institute/NIH, Bethesda, USA.
- Obeid M Department of Medicine, Service of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Vaccine and Immunotherapy Center, Centre Hospitalier Universitaire Vaudois (CHUV), Centre d'Immunothérapie et de Vaccinologie, Lausanne, Switzerland. Electronic address: michel.obeid@chuv.ch.
- 2020-03-21
Published in:
- Annals of oncology : official journal of the European Society for Medical Oncology. - 2020
CTLA-4
autoimmune disorders
checkpoint inhibitors
immune-related adverse events
solid organ transplantation recipients
English
Patients with cancer and with preexisting active autoimmune diseases (ADs) have been excluded from immunotherapy clinical trials because of concerns for high susceptibility to the development of severe adverse events resulting from exacerbation of their preexisting ADs. However, a growing body of evidence indicates that immune-checkpoint inhibitors (ICIs) may be safe and effective in this patient population. However, baseline corticosteroids and other nonselective immunosuppressants appear to negatively impact drug efficacy, whereas retrospective and case report data suggest that use of specific immunosuppressants may not have the same consequences. Therefore, we propose here a two-step strategy. First, to lower the risk of compromising ICI efficacy before their initiation, nonselective immunosuppressants could be replaced by specific selective immunosuppressant drugs following a short rotation phase. Subsequently, combining ICI with the selective immunosuppressant could prevent exacerbation of the AD. For the most common active ADs encountered in the context of cancer, we propose specific algorithms to optimize ICI therapy. These preventive strategies go beyond current practices and recommendations, and should be practiced in ICI-specialized clinics, as these require multidisciplinary teams with extensive knowledge in the field of clinical immunology and oncology. In addition, we challenge the exclusion from ICI therapy for patients with cancer and active ADs and propose the implementation of an international registry to study such novel strategies in a prospective fashion.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.annonc.2020.03.285
- PMID 32194150
- Persistent URL
- https://sonar.ch/global/documents/68422
Statistics
Document views: 12
File downloads:
- fulltext.pdf: 0