Therapy with Immune Checkpoint Inhibitors for Solid Tumors in Patients with Preexisting Systemic Autoimmune Diseases

Area of Science:

• Oncology
• Rheumatology
• Immunology

Background:

• Patients with systemic autoimmune diseases (SAID) face increased risks of neoplasms, including solid tumors and hematologic malignancies.
• Chronic immune stimulation and certain treatments contribute to elevated solid tumor risk in SAID patients.
• SAID patients are often excluded from clinical trials but receive immune checkpoint inhibitors (ICI) in practice.

Purpose of the Study:

• To review current literature on the efficacy and safety of ICI for solid tumors in SAID patients.
• To consolidate information on ICI use in this specific patient subgroup.

Main Methods:

• A comprehensive literature review was conducted using PubMed, Medline, Scopus, and Google Scholar.
• Included studies comprised retrospective analyses, systematic reviews, and meta-analyses focusing on ICI for solid tumors in SAID.
• Descriptive analysis covered ICI efficacy and safety in lung, melanoma, cutaneous, renal, and urothelial cancers.

Main Results:

• Immune checkpoint inhibitor (ICI) treatment appears generally safe for patients with asymptomatic systemic autoimmune diseases (SAID).
• Close multidisciplinary team follow-up is crucial during ICI therapy.
• Pre-treatment substitution of non-selective immunosuppressants (NSIM) with selective immunosuppressants (SIM) is advised for asymptomatic SAID patients.

Conclusions:

• ICI therapy can be considered safe for asymptomatic SAID patients with careful management.
• Proactive immunosuppressant modification and vigilant monitoring are key for optimizing ICI treatment outcomes in SAID.
• Multidisciplinary care ensures comprehensive management of SAID patients undergoing ICI therapy.