Pre-existing autoimmune disease ups risk of immune-related adverse events in melanoma patients
Cutaneous melanoma patients with a pre-existing autoimmune disease (pAID) are at substantially greater risk of immune-related adverse events (irAEs), reveals a recent study.
Patients with cutaneous melanoma who had pAID or received immune checkpoint inhibitor (ICI) therapy or both were identified using data from the Surveillance, Epidemiology, and End Results cancer registries and linked Medicare claims between January 2010 and December 2015. The investigators then stratified patients into the following groups: ICI+pAID, non-ICI+pAID, and ICI+non-pAID. Finally, they assessed the risk of cardiac, pulmonary, endocrine, and neurological irAE by fitting inverse probability of treatment weighted Cox proportional hazards regression models.
Of the 3,704 participants, 2,706 (73.1 percent) were classified non-ICI+pAID, while 106 (2.9 percent) and 892 (24.1 percent) were stratified into ICI+pAID and ICI+non-pAID, respectively.
Patients in the ICI+pAID group had a higher risk of irAE than those in the non-ICI+pAID (cardiac: hazard ratio [HR], 3.59, 95 percent confidence interval [CI], 2.83–4.55; pulmonary: HR, 3.94, 95 percent CI, 3.23–4.81; endocrine: HR, 1.72, 95 percent CI, 1.53–1.93; neurological: HR, 3.88, 95 percent CI, 2.30–6.57) and ICI+non-pAID groups (cardiac: HR, 3.83, 95 percent CI, 3.39–4.32; pulmonary: HR, 2.08, 95 percent CI, 1.87–2.32; endocrine: HR, 1.23, 95 percent CI, 1.14–1.32; neurological: HR, 3.77, 95 percent CI, 2.75–5.18).
“Further research examining the clinical impact of these events on the patients’ oncological outcome and quality of life is urgently needed given our findings of significantly worse rates of AEs,” the investigators said.