Don’t deny RA patients cancer immunotherapy

Patients with pre-existing rheumatoid arthritis receiving immune checkpoint inhibitors for malignancy experience severe immune related Adverse Events (irAEs) at a similar rate to other cancer patients without autoimmune diseases.

A study of 84 RA patients with cancers such as melanoma and non-small cell lung cancer and pre-existing autoimmune conditions found 41% of patients developed irAEs any grade and 9% developed severe, grade 3 irAEs.

The most common irAEs were dermatitis and colitis.

The checkpoint inhibitors, pembrolizumab, nivolumab and ipilimumab, were temporarily discontinued due to irAEs in 23% of patients and permanently in just one patient.

Flares of their pre-existing disease occurred in more than half (55%) of 22 patients with rheumatoid arthritis. Most had no active disease at the time of treatment with the checkpoint inhibitors.

Three quarters (75%) of the patients with flares received oral corticosteroid treatment.

Overall either flare, irAE or both occurred in 73% of rheumatoid arthritis patients.

Lead author Dr Sabina Sandigursky, from the New York University Langone Medical Center, said patients with rheumatoid arthritis were at a greater risk of certain cancers than the general population but were excluded from immunotherapy cancer trials due to fear of disease flare.

“However, patients with autoimmune diseases have the potential to benefit from the use of these therapies,” she said.

“Our data suggests that patients with RA may be treated with immunotherapy and attain rates of response that is similar to the general population at large with a 50 percent flare rate. There are ongoing clinical trials evaluating this question in a prospective nature.”

“A co-management approach between the oncologist and rheumatologist can help recognise and treat immunotherapy related toxicities if they do arise,” she said.

The study was presented at the 2019 ACR/ARP Annual Meeting.

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