ASCO 2022 | Association of pre-existing autoimmune disease & irAEs secondary to ICI therapy
Anna Claire Olsson-Brown, MBChB, The Clatterbridge Cancer Centre, Birkenhead, UK, discusses data from a large, real-world UK multicenter cohort on the association of pre-existing autoimmune disease (AID) and immune-related adverse events (irAEs) secondary to immune checkpoint inhibition therapy. Patients had received immune checkpoint inhibitors (ICIs) as standard of care (SOC) for melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). The presence of pre-existing AIDs was correlated with clinically significant immune-related adverse events (iAEs). Overall, the study demonstrated pre-existing AIDs as a predisposing factor for the occurrence of iAEs. Interestingly, patients with pre-existing AIDs had superior overall survival (OS) versus those without, which had not previously been reported. This interview took place at the American Society of Clinical Oncology (ASCO) 2022 Annual Meeting in Chicago, IL.
Transcript (edited for clarity)
We’ve looked at a retrospective analysis, looking at the involvement and importance of pre-autoimmune diseases in the manifestation of immune adverse event, secondary to immunotherapy. So that is really a point of interest, because it’s quite an unmet answer question during the clinical trials that have been done in immune checkpoint inhibitors. So I’m part of a collaborative called the UK National Oncology Trainee Collaboration for Healthcare Research, and we’re essentially a multicenter collaboration, using the sort of utility of doing lots of baseline audits, and retrospective analysis, but coming together to do that in a much more impactful fashion...
We’ve looked at a retrospective analysis, looking at the involvement and importance of pre-autoimmune diseases in the manifestation of immune adverse event, secondary to immunotherapy. So that is really a point of interest, because it’s quite an unmet answer question during the clinical trials that have been done in immune checkpoint inhibitors. So I’m part of a collaborative called the UK National Oncology Trainee Collaboration for Healthcare Research, and we’re essentially a multicenter collaboration, using the sort of utility of doing lots of baseline audits, and retrospective analysis, but coming together to do that in a much more impactful fashion. So we wanted to look at the involvement of immune adverse events, and try answer questions that we couldn’t answer in clinical trials.
So one of those is because patients with autoimmune diseases aren’t normally enrolled in clinical trials with immune therapies, because they’re at high approval and theoretical higher risk of immune adverse events. So actually, we don’t know in clinical practice whether we should be treating these patients or not. So we undertook a retrospective analysis of around 2049 patients to try and understand whether people who have got autoimmune disease are at higher risk. So what we found was about 13% of the total population of patients treated in that 2049 cohort had pre-existing autoimmune diseases. And that was a full spectrum of different autoimmune diseases, both autoantibody driven, and autoinflammatory.
And essentially, what we looked at as to whether they had higher rates of toxicity, so they do. So about 45% of patients with a pre-existing autoimmune disease get immune adverse events, compared to about 33% of those without, which is a significant difference. However, it is lower than of the smaller studies have shown, so that’s quite a reassuring sign. The other thing that we found is that, actually, they do seem to have a significantly improved overall survival compared to their non-pre-existing autoimmune disease counterparts, which is interesting.
And when we’ve done an interaction analysis, that doesn’t seem to be related entirely to the fact that they get more toxicity, but actually, they seem to have an independent survival benefit in their own right. So I think it’s been quite reassuring, in the fact that we thought we would see higher toxicity, I don’t think that toxicity is as high as we thought it was going to be, but also, it tends that these patients are likely to get a survival benefit as well, which is really reassuring when we’re looking at it from a clinical perspective in the clinic going, “Is the risk benefit worth it?” I think both of those facts are really quite important, and possibly practice changing. We just now need to prove it in a prospective manner.
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