Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy.

Autor:	Halle BR; Vanderbilt University School of Medicine, Nashville, Tennessee, USA briana.r.halle@vanderbilt.edu., Betof Warner A; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Zaman FY; Alfred Hospital, Melbourne, Victoria, Australia., Haydon A; Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia., Bhave P; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Dewan AK; Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Ye F; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Irlmeier R; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Mehta P; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Kurtansky NR; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Lacouture ME; Memorial Sloan Kettering Cancer Center, New York, New York, USA., Hassel JC; Department of Dermatology, NCT, University Hospital Heidelberg, Heidelberg, Germany., Choi JS; Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Sosman JA; Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Chandra S; Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Otto TS; Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.; Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA., Sullivan R; Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA., Mooradian MJ; Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA., Chen ST; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA., Dimitriou F; Melanoma Institute Australia, North Sydney, New South Wales, Australia.; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland., Long G; Melanoma Institute Australia, North Sydney, New South Wales, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia., Carlino M; Melanoma Institute Australia, North Sydney, New South Wales, Australia.; Westmead Hospital, Westmead, New South Wales, Australia., Menzies A; Melanoma Institute Australia, North Sydney, New South Wales, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia., Johnson DB; Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Rotemberg VM; Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	Journal for immunotherapy of cancer [J Immunother Cancer] 2021 Oct; Vol. 9 (10).
DOI:	10.1136/jitc-2021-003066
Abstrakt:	Background: Immune checkpoint inhibitors (ICIs) are approved to treat multiple cancers. Retrospective analyses demonstrate acceptable safety of ICIs in most patients with autoimmune disease, although disease exacerbation may occur. Psoriasis vulgaris is a common, immune-mediated disease, and outcomes of ICI treatment in patients with psoriasis are not well described. Thus we sought to define the safety profile and effectiveness of ICIs in patients with pre-existing psoriasis. Methods: In this retrospective cohort study, patients from eight academic centers with pre-existing psoriasis who received ICI treatment for cancer were evaluated. Main safety outcomes were psoriasis exacerbation and immune-related adverse events (irAEs). We also assessed progression-free survival (PFS) and overall survival. Results: Of 76 patients studied (50 (66%) male; median age 67 years; 62 (82%) with melanoma, 5 (7%) with lung cancer, 2 (3%) with head and neck cancer, and 7 (9%) with other cancers; median follow-up 25.1 months (range=0.2-99 months)), 51 (67%) received anti-PD-1 antibodies, 8 (11%) anti-CTLA-4, and 17 (22%) combination of anti-PD-1/CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (46 patients (61%)) and 15 (20%) with psoriatic arthritis. Forty-one patients (54%) had received any prior therapy for psoriasis although only two (3%) were on systemic immunosuppression at ICI initiation. With ICI treatment, 43 patients (57%) experienced a psoriasis flare of cutaneous and/or extracutaneous disease after a median of 44 days of receiving ICI. Of those who experienced a flare, 23 patients (53%) were managed with topical therapy only; 16 (21%) needed systemic therapy. Only five patients (7%) required immunotherapy discontinuation for psoriasis flare. Forty-five patients (59%) experienced other irAEs, 17 (22%) of which were grade 3/4. PFS with landmark analysis was significantly longer in patients with a psoriasis flare versus those without (39 vs 8.7 months, p=0.049). Conclusions: In this multicenter study, ICI therapy was associated with frequent psoriasis exacerbation, although flares were manageable with standard psoriasis treatments and few required ICI discontinuation. Patients who experienced disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy. Competing Interests: Competing interests: DBJ has served on advisory boards for BMS, Catalyst Biopharma, Iovance, Jansen, Merck, Novartis, Oncosec, and Pfizer; and received research funding from BMS and Incyte. JCH declares research support from Bristol Myers Squibb; advisory board honoraria from Pierre Fabre, Sanofi, Sun Pharma and Merck Sharp & Dome; speakers honoraria from Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Roche, Sanofi and Almirall; and travel support from Pierre Fabre. AM has served on advisory boards for BMS, MSD, Novartis, Roche, Pierre-Fabre and QBiotics. GL is consultant advisor for Aduro Biotech, Amgen, Array Biopharma, Boehringer Ingelheim International, Bristol-Myers Squibb, Highlight Therapeutics, Merck Sharpe & Dohme, Novartis Pharma, Pierre Fabre, QBiotics Group Limited, and Regeneron Pharmaceuticals. PB declares travel support from MSD; and advisory board honoraria from Novartis. MC is a consultant advisor for Amgen, BMS, Eisai, Ideaya, MSD, Nektar, Novartis, Oncosec, Pierre-Fabre, Qbiotics, Regeneron, Roche, Provectus and Sanofi. AH has served on advisory boards for BMS, MSD, Novartis, Pierre-Fabre and QBiotics. MEL consults with Johnson and Johnson, Novocure, QED, Bicara, Janssen, Novartis, F Hoffmann-La Roche, EMD Serono, AstraZeneca, Innovaderm, Deciphera, DFB, Azitra, Kintara, RBC/La Roche Posay, Trifecta, Varsona, Genentech, Loxo, Seattle Genetics, Lutris, OnQuality, Azitra, Roche, Oncoderm, NCODA, and Apricity. MEL receives research funding from Lutris, Paxman, Novocure, J&J, US Biotest, OQL, Novartis and AZ; and is funded in part through NIH/NCI Cancer Center Support Grant P30 CA008748. MJM has served as a consultant and/or received honorarium from AstraZeneca Pharmaceuticals, Catalyst Pharmaceuticals, Nektar Therapeutics and Immunai. STC serves on the Pfizer Advisory Board on digital media and the BOD for Medical Dermatology Society and is the Chair for Organisational Structure Committee of the AAD. ABW and VMR are supported by the NIH/NCI Cancer Center Support Grant P30 CA008748. VMR is funded by the Melanoma Research Alliance Young Investigator Award 614197 and an expert advisor for Inhabit Brands, Inc. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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