(1) Gutzmer R (2) Koop A (3) Meier F (4) Hassel JC (5) Terheyden P (6) Zimmer L (7) Heinzerling L (8) Ugurel S (9) Pfohler C (10) Gesierich A (11) Livingstone E (12) Satzger I (13) Kahler KC
(1) Gutzmer R (2) Koop A (3) Meier F (4) Hassel JC (5) Terheyden P (6) Zimmer L (7) Heinzerling L (8) Ugurel S (9) Pfohler C (10) Gesierich A (11) Livingstone E (12) Satzger I (13) Kahler KC
AIM: Programmed cell death protein 1 (PD-1) inhibitors are a common treatment strategy for metastatic melanoma and other tumour entities. Clinical trials usually exclude patients with preexisting autoimmune diseases, thus experience with PD-1 inhibitor (PD-1i) in this patient population is limited. PATIENTS AND METHODS: Metastatic melanoma patients with preexisting autoimmune disorders or previous ipilimumab-triggered immune-related adverse events (irAE) undergoing treatment with PD-1i from seven German skin cancer centres were evaluated retrospectively with regard to flare of the preexisting autoimmunity and development of new, not preexisting irAE as well as response to PD-1i therapy. RESULTS: In total, 41 patients had either preexisting autoimmunity (n=19, group A, including two patients with additional ipilimumab-triggered autoimmune colitis) or ipilimumab-triggered irAE (n=22, group B). At PD-1i therapy initiation, six patients in group A and two patients in group B required immunosuppressive therapy. In group A, a flare of preexisting autoimmune disorders was seen in 42% of patients, new irAE in 16%. In group B, 4.5% of patients showed a flare of ipilimumab-triggered irAE and 23% new irAE. All flares of preexisting autoimmune disorders or irAE were managed by immunosuppressive and/or symptomatic therapy and did not require termination of PD-1i therapy. tumour responses (32% in group A and 45% in group B) were unrelated to occurrence of autoimmunity. CONCLUSION: While preexisting autoimmunity commonly showed a flare during PD-1i therapy, a flare of ipilimumab-triggered irAE was rare. Response rates were above 30% and unrelated to irAE. PD-1i therapy can be considered in patients with autoimmune disorders depending on severity and activity of autoimmunity.
Author Info: (1) Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany. Electronic address: Gutzmer.ralf@mh-hannover.de. (2) Skin Cancer Center Hann
Author Info: (1) Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany. Electronic address: Gutzmer.ralf@mh-hannover.de. (2) Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany. Electronic address: Koop.anika@mh-hannover.de. (3) Department of Dermatology and National Center for Tumor Diseases, University Hospital Carl Gustav at the TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany. Electronic address: Friedegund.meier@uniklinikum-dresden.de. (4) Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany. Electronic address: Jessica.hassel@med.uni-heidelberg.de. (5) Department of Dermatology, University of Lubeck, Ratzeburger Allee 160, 23562 Luebeck, Germany. Electronic address: Patrick.terheyden@uksh.de. (6) Department of Dermatology, University of Duisburg-Essen, Essen, Germany. Electronic address: lisa.zimmer@uk-essen.de. (7) University Hospital Erlangen, Department of Dermatology, Erlangen, Germany. Electronic address: lucie.heinzerling@uk-erlangen.de. (8) Department of Dermatology, University of Duisburg-Essen, Essen, Germany. Electronic address: selma.ugurel@uk-essen.de. (9) Saarland University Medical School, Department of Dermatology, Homburg, Germany. Electronic address: Claudia.pfoehler@uks.eu. (10) University Hospital Wurzburg, Department of Dermatology, Wurzburg, Germany. Electronic address: gesierich_a@ukw.de. (11) Department of Dermatology, University of Duisburg-Essen, Essen, Germany. Electronic address: elisabeth.livingstone@uk.essen.de. (12) Skin Cancer Center Hannover, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany. Electronic address: Satzger.imke@mh-hannover.de. (13) Department of Dermatology, Skin Cancer Center, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany. Electronic address: kckaehler@yahoo.de.
Citation: Eur J Cancer 2017 Feb 16 75:24-32 Epub02/16/2017
