Should we be Afraid of Immune Check Point Inhibitors in Cancer Patients with Pre-Existing Rheumatic Diseases? Immunotherapy in Pre-Existing Rheumatic Diseases

Kalliopi Klavdianou; Konstantinos Melissaropoulos; Alexandra Filippopoulou; Dimitrios Daoussis

doi:10.31138/mjr.32.3.218

Should we be Afraid of Immune Check Point Inhibitors in Cancer Patients with Pre-Existing Rheumatic Diseases? Immunotherapy in Pre-Existing Rheumatic Diseases

Mediterr J Rheumatol. 2021 Sep 30;32(3):218-226. doi: 10.31138/mjr.32.3.218. eCollection 2021 Sep.

Authors

Kalliopi Klavdianou¹, Konstantinos Melissaropoulos², Alexandra Filippopoulou³, Dimitrios Daoussis⁴

Affiliations

¹ Department of Rheumatology, "Asklepieion" General Hospital, Athens, Greece.
² Department of Rheumatology, Agios Andreas Hospital, Patras, Greece.
³ Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁴ Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece.

Abstract

Background: Cancer immunotherapy is rapidly expanding but its clinical efficacy is hampered by immune related adverse events (ir-AE). There is a concern regarding patients with pre-existing auto-immune diseases (PAD) undergoing immunotherapy.

Methods: An electronic search was performed (Medline) to identify cases of patients with PAD treated with immune checkpoint inhibitors (ICI).

Results: Published data are rather limited but continue to emerge. Patients with PAD exhibit a high risk of PAD flare and/or de novo ir-AE. In most cases PAD flares and de novo irAEs were not severe and could be managed effectively with standard treatment.

Conclusions: This risk in patients with PAD appears acceptable, and therefore, these patients could receive immunotherapy under close monitoring. Collaboration of oncologists and rheumatologists for the management of these patients is crucial.

Keywords: cancer immunotherapy pre-existing rheumatic diseases; immune checkpoint inhibitors; rheumatic diseases.

Publication types

Review