Canadian Rheumatology Association/Canadian Research Group of Rheumatology in Immuno-Oncology Living Guidelines for...

Area of Science:

• Rheumatology
• Oncology
• Immunology
• Clinical Guidelines

Background:

• Immune checkpoint inhibitors (ICIs) are increasingly used in cancer patients.
• Patients with preexisting systemic autoimmune rheumatic diseases (SARDs) present unique challenges.
• Concerns exist regarding the impact of baseline immunosuppression on cancer outcomes versus SARD flare risk.

Purpose of the Study:

• To develop a living guideline for managing baseline immunosuppression in cancer patients with SARDs initiating ICI therapy.
• To provide up-to-date recommendations balancing SARD management and cancer treatment efficacy.
• To address the critical decision of continuing or modifying immunosuppression during immuno-oncology treatment.

Main Methods:

• A multidisciplinary panel (rheumatologists, oncologists, researchers, patient representative) was formed.
• A systematic literature review was conducted to inform the guideline.
• Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Main Results:

• Eight best practice statements were developed, emphasizing shared decision-making and risk assessment.
• Seven specific recommendations were made for various SARDs (e.g., lupus, scleroderma, Sjögren's).
• General recommendation: continue baseline immunosuppression, especially for organ- or life-threatening SARD manifestations.

Conclusions:

• This living guideline offers contemporary recommendations for managing immunosuppression in cancer patients with SARDs undergoing ICI therapy.
• Recommendations will be updated regularly and made available online.
• The guideline aims to optimize care by considering both autoimmune disease activity and cancer treatment response.