Immune checkpoint inhibitors in cancer patients with pre-existing autoimmune disease: Comparative safety and efficacy in a registered systematic review.
Ziyue Wang, Xu Wang
✦ AI-curated · Sources linked
In 30 seconds
This registered systematic review and restricted meta-analysis compared immune checkpoint inhibitor (ICI) safety and efficacy in cancer patients with versus without pre-existing autoimmune disease (AID). Twenty-five studies were included; five contributed to the any-grade immune-related adverse event (irAE) meta-analysis and four to the grade ≥ 3 analysis. Pre-existing AID was associated with more any-grade irAEs (risk ratio [RR] 1.34, 95% confidence interval [CI] 1.13-1.60). The estimate for grade ≥ 3 irAEs was inconclusive, and available evidence could not establish whether AID modified antitumour efficacy.
Key findings
- Pre-existing AID was associated with increased any-grade irAEs (RR 1.34, 95% CI 1.13-1.60).
- The comparative estimate for grade ≥ 3 irAEs was inconclusive (RR 0.99, 95% CI 0.66-1.47).
- Available data were insufficient to determine whether pre-existing AID modified antitumour efficacy.
Why it matters
The findings distinguish an increased likelihood of any-grade immune toxicity from the still-uncertain evidence on severe toxicity and antitumour efficacy. This helps frame discussions about ICI use in patients with pre-existing AID without treating all autoimmune disease as an automatic barrier to cancer immunotherapy.
What to keep in mind
Only five studies contributed to the any-grade irAE meta-analysis and four to the grade ≥ 3 analysis; available data were insufficient to determine effects on antitumour efficacy.