Another concern is a reluctance to expose those with autoimmune disease to ICIs. In this cohort, 94% of patients received immunotherapy for their cancers only after failing conventional chemotherapy regimens. This suggests that RD may be a factor in delaying immunotherapy treatments.
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There is also worry about the generalizability of the results due to the advanced stages of cancer that were seen before immunotherapy was instituted. This may be another indication of delay because ICI treatments are being used more often as first-line agents for many advanced malignancies.
Further research is needed. Dr. Thanarajasingam is following patients with preexisting RD and those who develop it following exposure to the inhibitors. She would like to know if there is any impact on the response of their cancer. There is also a need to answer questions about how to intervene during a flare to minimize the impact on cancer treatment.
“Because ICIs have shown such dramatic responses in advanced cancer, their use has been expanding to many different forms of cancer,” says Dr. Thanarajasingam. “I want physicians to not immediately exclude their RD patients from eligibility just because they have existing autoimmune disease. This study would support using immunotherapy in a select group who can be followed closely by both oncology and rheumatology.”
Kurt Ullman has been a freelance writer for more than 30 years and a contributing writer to The Rheumatologist for 10 years.
- Richter MD, Pinkston O, Kottschade LA, et al. Brief report: Cancer immunotherapy in patients with preexisting rheumatic disease: The Mayo Clinic experience. Arthritis Rheumatol. 2018 Mar;70(3):356–360.