Cancer immunotherapy with checkpoint inhibitors (CPIs) is associated with frequent immune-related adverse events (irAEs), some of which may be severe and fatal, thus these agents are often not recommended for patients with concomitant autoimmune disease.
An editorial notes that patients with immune-mediated inflammatory diseases (IMIDs) were excluded from the clinical trials that have provided much of the information on the toxicity profiles of CPIs, thus a series of questions for these patients with cancer remain unanswered. It adds that systematic reviews, including the current one, are typically limited by reporting bias and quality, and retrospective reports have many flaws and are inherently influenced by channeling bias.
The commentator highlights a few areas of immediate concern among clinicians who treat patients with IMIDs:
• There is a need for biomarkers to help predict which patients with IMIDs who are receiving CPI therapy will have a flare or develop irAEs.
• For the many patients with IMIDs and cancer who receive some form of immunosuppression for serious disease, prospective evaluation of the effect of the classes and doses of drugs on the efficacy and toxicity of CPIs is urgently needed.
• Maintenance of pharmacovigilance is important given that many new CPIs and novel immunotherapies are entering clinical trials.