Leonardi GC, et al. - Researchers determined if the use of programmed death (PD)-1 and PD-ligand 1 (PD-L1) inhibitors in patients with non–small-cell lung cancer (NSCLC) and underlying autoimmune disease (AID) is safe. They found that among patients with NSCLC with AID treated with a PD-(L)1 inhibitor, AID was exacerbated in a minority of patients. Compared to reported rates in clinical trials where patients with AID were excluded, a similar incidence of immune-related adverse events (irAEs) was reported in this study. Data showed generally manageable adverse events, which occasionally was the reason for immunotherapy being permanently discontinued.

Methods

• Retrospective collection of clinicopathologic data from patients with NSCLC and a history of AID who received monotherapy with either a PD-1 or a PD-L1 (referred to as PD-[L]1) inhibitor, was accomplished as a part of a multi-institutional effort.
• Qualifying AIDs included, but was not limited to: rheumatologic, neurologic, endocrine, GI, and dermatologic conditions.

Results

• This study included 56 patients with NSCLC and an AID who received a PD-(L)1 inhibitor.
• Active AID symptoms were present in 18% of patients and 20% were receiving immunomodulatory agents for their AID at the time of treatment initiation.
• An AID flare and/or an immune-related adverse event (irAE) was experienced by 55% of patients.
• A total of 13 patients (23% of the whole cohort) experienced exacerbation of the AID; systemic corticosteroids was needed for four of these patients.
• Occurrence of immune-related adverse events was reported in 21 patients (38%).
• Data showed that among irAEs, 74% were grade 1 or 2 and 26% were grade 3 or 4; eight patients required corticosteroids for irAE management.
• Findings showed irAEs accounted for permanent discontinuation of PD-(L)1 therapy in eight patients (14%).
• The overall response rate to immunotherapy was 22%.