Immune Checkpoint Inhibitors and Lupus Erythematosus

Author:

Vitzthum von Eckstaedt Hans1,Singh Arohi2,Reid Pankti34ORCID,Trotter Kimberly4

Affiliation:

1. Department of Medicine, University of Chicago Medicine, Chicago, IL 60637, USA

2. College of the University of Chicago, University of Chicago, Chicago, IL 60637, USA

3. Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago Medicine, Chicago, IL 60637, USA

4. Department of Medicine, Section of Rheumatology, University of Chicago Medicine, Chicago, IL 60637, USA

Abstract

Immune checkpoint inhibitors (ICIs) are the standard of care for a growing number of malignancies. Unfortunately, they are associated with a broad range of unique toxicities that mimic the presentations of primary autoimmune conditions. These adverse events are termed immune-related adverse events (irAEs), of which ICI-lupus erythematosus (ICI-LE) constitutes a small percentage. Our review aims to describe the available literature on ICI-LE and ICI treatment for patients with pre-existing lupus. Most diagnoses of ICI-LE had findings of only cutaneous lupus; four diagnoses of ICI-LE had systemic lupus manifestations. Over 90% (27 of 29) of cases received anti-PD-1/PDL-1 monotherapy, 1 received combination therapy, and 1 received only anti-CTLA-4 treatment. About three-fourths (22 of 29 or 76%) of patients with ICI-lupus were managed with topical steroids, 13 (45%) received hydroxychloroquine, and 10 (34%) required oral corticosteroids. In our case series, none of the patients with pre-existing lupus receiving ICI therapy for cancer had a flare of their lupus, but few had de novo irAE manifestations, all of which were characterized as low-grade. The review of the literature yielded seven ICI-LE flares from a total of 27 patients with pre-existing lupus who received ICI. Most flares were manageable without need for ICI cessation.

Funder

SECURED

National Cancer Institute

Publisher

MDPI AG

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5. Albandar, H.J., Fuqua, J., Albandar, J.M., Safi, S., Merrill, S.A., and Ma, P.C. (2021). Immune-related adverse events (Irae) in cancer immune checkpoint inhibitors (ici) and survival outcomes correlation: To rechallenge or not?. Cancers, 13.

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