Immune Checkpoint Inhibitor Therapy in Patients With Autoimmune Disease
Abstract:
Immune checkpoint inhibitors have demonstrated efficacy across many cancer types in numerous clinical trials. However, because patients with preexisting autoimmune disease were excluded from these seminal trials, there are serious gaps in knowledge regarding the efficacy-and in particular the safety-of these transformative agents in patients with autoimmune disease. The safety of immune checkpoint inhibitors in this population has been an important concern, since these agents unleash immune activation, a potentially dangerous situation for patients with already heightened and aberrant immune function. Several retrospective studies have begun to address this question, finding that autoimmunity is often exacerbated by immune checkpoint inhibitor therapy, but is generally manageable with standard treatment algorithms and close multidisciplinary monitoring. Further, the activity of these agents appears to be comparable to that seen in unselected patients. Here we detail the experience with immune checkpoint inhibitors in patients with autoimmune disease.
Insights
Immune checkpoint inhibitors (ICIs) can exacerbate autoimmune disease but are generally manageable with standard treatments. The efficacy of ICIs in patients with autoimmune conditions appears comparable to that in other patient groups.
Area of Science:
- Oncology
- Immunology
- Rheumatology
Background:
- Immune checkpoint inhibitors (ICIs) show broad efficacy in cancer treatment.
- Patients with pre-existing autoimmune diseases (AD) were excluded from initial ICI trials, creating knowledge gaps.
- The safety and efficacy of ICIs in patients with AD are critical concerns due to potential immune hyperactivation.
Purpose of the Study:
- To review the safety and efficacy of ICIs in patients with pre-existing autoimmune diseases.
- To address the knowledge gaps concerning ICI use in this specific patient population.
Main Methods:
- Review of retrospective studies and clinical experiences.
- Analysis of safety data, including exacerbation of autoimmune conditions.
- Evaluation of treatment outcomes and efficacy compared to unselected patients.
Main Results:
- Autoimmune conditions are frequently exacerbated by ICI therapy.
- Exacerbated autoimmunity is generally manageable with established treatment protocols and multidisciplinary care.
- ICI efficacy in patients with AD appears comparable to that observed in patients without AD.
Conclusions:
- ICIs can be safely administered to patients with autoimmune diseases, with careful monitoring.
- Management strategies exist to mitigate ICI-related autoimmune exacerbations.
- The therapeutic benefit of ICIs extends to patients with pre-existing autoimmune conditions.
Related Concept Videos
02:19The Spindle Assembly Checkpoint
Many proteins function together to control the spindle assembly checkpoint. Mutations affecting these proteins may allow cells to proceed into anaphase prematurely, resulting in the...
01:38What is the Immune System?
01:52Eukaryotic Transcription Inhibitors
Eukaryotic transcription inhibitors usually contain two distinct domains, a...
00:59Gene Therapy
01:13Acid Suppressive Drugs for Peptic Ulcer Disease: Proton Pump Inhibitors
Gastric acid, a potent cocktail of hydrogen and chloride ions, is produced in specialized parietal cells within the...
01:29Autoimmune Disorders
Concept and Mechanism of Autoimmune Diseases
The immune...