Abstract 577P
Background
Patients with baseline autoimmune diseases were excluded from almost all clinical trials of immune checkpoint inhibitors (ICPIs). The evaluation of ICPIs use in this category is an unmet need, especially in the real-world setting.
Methods
We analyzed all cancer patients who received ICPIs from 2015 to 2020 in Qatar and had baseline auto immune diseases. Survival outcomes, incidence, and characteristics of irAEs were evaluated. Moreover, we evaluated the time of onset (t days) of irAEs described as hyperacute (very early t= 1 to 21 days of initiation of ICPI, acute (early) (t > 21 and < 180 days), late (t > 180 and < 365 days) & delayed (t = or > 365 days).
Results
We evaluated 236 unique patients who used 255 ICPI agents. We identified 8 patients who were treated with 11 ICPIs and 10 autoimmune diseases in total. Most patients had good performance status and were on baseline immunosuppressants, n = 5 (62.5%). The median duration of treatment was 40.1 weeks (9.1–96.0). Nivolumab was the most used agent, n = 7 (64%). ICPIs were used as second line, n=5 (45.5%). We identified a total of 11 irAEs, where endocrine irAEs were the most common, n = 5 (45.4%), followed by dermatologic irAEs, n = 2 (18.2%). Notably, there were two cases of flare-up of baseline psoriasis (t = 368) and Sjogren syndrome (t = 65). Another patient with baseline IBD developed grade 3 colitis (t = 25). Most irAEs were grade 2, n = 9 (81.8%), except for 2 irAEs of grade 3 (colitis and massive pericardial effusion). Most irAEs were of acute onset, n = 7 (63.7%), while 4 irAEs (36.4%) were of delayed onset. Most irAEs resolved, except for four instances that did not: one case each of hypothyroidism, pneumonitis, AKI, and a flare-up of Sjogren's syndrome. ICPI was temporarily discontinued in one case due to massive pericardial effusion but was permanently discontinued in another case of pneumonitis. The median overall survival (OS) was 498 days (1732–196), while the median progression free survival (PFS) was 498 days (898–117).
Conclusions
Despite having two cases of auto-immune disease flare-ups. This study suggests that ICPIs are generally tolerable with good survival outcomes for patients with baseline controlled auto-immune diseases; however, further research is warranted to validate these findings.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
N.E. Omar.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.