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Association Between Rheumatic Autoantibodies and Immune-Related Adverse Events.
Mathias, Kristen; Rouhani, Sherin; Olson, Daniel; Bass, Anne R; Gajewski, Thomas F; Reid, Pankti.
Afiliação
  • Mathias K; Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
  • Rouhani S; Department of Medicine, Section of Hematology Oncology, Chicago, IL, USA.
  • Olson D; Department of Medicine, Section of Hematology Oncology, Chicago, IL, USA.
  • Bass AR; Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA.
  • Gajewski TF; Department of Medicine, Section of Hematology Oncology, Chicago, IL, USA.
  • Reid P; Committee on Clinical Pharmacology and Pharmacogenomics, Chicago, IL, USA.
Oncologist ; 28(5): 440-448, 2023 05 08.
Article em En | MEDLINE | ID: mdl-36595378
ABSTRACT

BACKGROUND:

Side effects of immune checkpoint inhibitors (ICIs), called immune-related adverse events (irAEs), closely resemble primary autoimmune or rheumatic diseases. We aimed to understand the clinical utility of rheumatic autoantibodies (rhAbs) for diagnosing irAEs. PATIENTS AND

METHODS:

Patients without pre-existing autoimmune disease (pAID) who had cancer treated with ICI(s) treatment from 1/1/2011 to 12/21/2020 and a rhAb checked were retrospectively identified. Logistic regression assessed associations between autoantibodies and irAEs, cancer outcome, and survival. Specificity, sensitivity, and positive/negative predictive values (PPV, NPV) were estimated for key rhAbs and ICI-arthritis. Kaplan-Meier analyzed objective response rate (ORR) and overall survival (OS).

RESULTS:

A total of 2662 patients were treated with≥1 ICIs. One hundred and thirty-five without pAID had ≥ 1 rhAb tested. Of which 70/135(52%) were female; median age at cancer diagnosis was 62 years with most common cancers melanoma (23%) or non-small cell lung cancer (21%), 96/135 (75%) were anti-PD1/PDL1 treated. Eighty had a rhAb ordered before ICI, 96 after ICI, and 12 before and after. Eighty-two (61%) experienced an irAE, 33 (24%) with rheumatic-irAE. Pre-ICI RF showed significant association with rheumatic-irAEs (OR = 25, 95% CI, 1.52-410.86, P = .024). Pre- and post-ICI RF yielded high specificity for ICI-arthritis (93% and 78%), as did pre- and post-ICI CCP (100% and 91%). Pre-ICI RF carried 93% NPV and pre-ICI CCP had 89% PPV for ICI-arthritis. No variables were significantly correlated with ORR. Any-type irAE, rheumatic-irAE and ICI-arthritis were all associated with better OS (P = .000, P = .028, P = .019).

CONCLUSIONS:

Pre-ICI RF was associated with higher odds of rheumatic-irAEs. IrAEs had better OS; therefore, clinical contextualization for rhAbs is critical to prevent unnecessary withholding of lifesaving ICI for fear of irAEs.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Artrite / Carcinoma Pulmonar de Células não Pequenas / Neoplasias Pulmonares Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Artrite / Carcinoma Pulmonar de Células não Pequenas / Neoplasias Pulmonares Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2023 Tipo de documento: Article