Safety profiles in the use of immune checkpoint inhibitors by patients with cancer and pre-existing autoimmune diseases.

IF 2.6 4区医学 Q1 MEDICINE, GENERAL & INTERNAL Medicina Clinica Pub Date : 2024-10-15 DOI:10.1016/j.medcli.2024.08.003

Júlia de Almeida Santos Freitas, Marinho Marques da Silva Neto, Cleverton Kleiton Freitas de Lima, Ney Cristian Amaral Boa Sorte, Maria Teresita Bendicho, Aníbal de Freitas Santos Júnior

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Abstract

Introduction: The treatment of cancer when associated with autoimmune diseases (AID) has been the subject of immunotherapy investigation, especially with the use of immune checkpoint inhibitors (ICI). Clinical studies have restricted the evaluation of its use in special populations such as patients with AID, leaving a gap regarding the safety of using immunotherapy.

Objective: Discuss the safety of using ICI in patients with cancer and AID, in specialized oncology units, in the cities of Bahia, Brazil.

Methods: Retrospective and quantitative cross-sectional study on immune-related adverse events (IRAE) to the use of ICI in patients with cancer and AID.

Results: Patients (39 with cancer, and 14 with AID and cancer) were studied. Men (between 30 and 95 years old), melanoma and lung cancer and Hashimoto's thyroiditis were predominance. Pembrolizumab and Nivolumab (anti-PDL-1) were drugs most used. In general, patients using anti-PDL-1 with AID had IRAE with greater frequency and severity: Grade 1 (57%) and 3/4 grades (43%) reactions. The gastrointestinal system presented a greater IRAE in both groups, however in patients with AID more severe reactions were found (0% versus 60%). Patients with cancer and AID had higher rates of IRAE compared to patients without AID, respectively, of discontinuation (50% versus 18%) and interruption (85% versus 20%) of treatment.

Conclusion: IRAE increased in patients using ICI with cancer and AID. This suggests that the presence of IAD, in cancer patients, can increase the severity of IRAE. Therefore, the adoption of more appropriate therapeutic strategies is essential for better therapeutic results.

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癌症和原有自身免疫性疾病患者使用免疫检查点抑制剂的安全性概况。

简介治疗伴有自身免疫性疾病（AID）的癌症一直是免疫疗法研究的主题，尤其是免疫检查点抑制剂（ICI）的使用。临床研究仅限于对免疫检查点抑制剂在自身免疫性疾病患者等特殊人群中的应用进行评估，因此在使用免疫疗法的安全性方面存在空白：目的：讨论在巴西巴伊亚州各城市的肿瘤专科医院对癌症和艾滋病患者使用 ICI 的安全性：方法：对癌症和艾滋病患者使用 ICI 后发生的免疫相关不良事件（IRAE）进行回顾性和定量横断面研究：研究对象包括 39 名癌症患者和 14 名患有艾滋病和癌症的患者。男性（30 至 95 岁）、黑色素瘤、肺癌和桥本氏甲状腺炎患者居多。使用最多的药物是 Pembrolizumab 和 Nivolumab（抗-PDL-1）。一般来说，使用抗PDL-1的AID患者发生IRAE的频率和严重程度更高：1级（57%）和3/4级（43%）反应。两组患者的胃肠道系统都出现了较多的 IRAE，但 AID 患者的反应更为严重（0% 对 60%）。与无 AID 患者相比，癌症患者和 AID 患者在中断治疗（50% 对 18%）和中断治疗（85% 对 20%）时的 IRAE 发生率分别更高：结论：使用 ICI 的癌症和 AID 患者的 IRAE 增加。这表明，癌症患者体内存在 IAD 会增加 IRAE 的严重程度。因此，采用更合适的治疗策略对于取得更好的治疗效果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medicina Clinica 医学-医学：内科

CiteScore

3.10

自引率

5.10%

发文量

295

审稿时长

22 days

期刊介绍： Medicina Clínica, fundada en 1943, es una publicación quincenal dedicada a la promoción de la investigación y de la práctica clínica entre los especialistas de la medicina interna, así como otras especialidades. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica.