TY - JOUR T1 - Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy JF - Journal for ImmunoTherapy of Cancer JO - J Immunother Cancer DO - 10.1136/jitc-2021-003066 VL - 9 IS - 10 SP - e003066 AU - Briana Rose Halle AU - Allison Betof Warner AU - Farzana Y Zaman AU - Andrew Haydon AU - Prachi Bhave AU - Anna K Dewan AU - Fei Ye AU - Rebecca Irlmeier AU - Paras Mehta AU - Nicholas R Kurtansky AU - Mario E Lacouture AU - Jessica C Hassel AU - Jacob S Choi AU - Jeffrey A Sosman AU - Sunandana Chandra AU - Tracey S Otto AU - Ryan Sullivan AU - Meghan J Mooradian AU - Steven T Chen AU - Florentia Dimitriou AU - Georgina Long AU - Matteo Carlino AU - Alexander Menzies AU - Douglas B Johnson AU - Veronica M Rotemberg Y1 - 2021/10/01 UR - http://jitc.bmj.com/content/9/10/e003066.abstract N2 - Background Immune checkpoint inhibitors (ICIs) are approved to treat multiple cancers. Retrospective analyses demonstrate acceptable safety of ICIs in most patients with autoimmune disease, although disease exacerbation may occur. Psoriasis vulgaris is a common, immune-mediated disease, and outcomes of ICI treatment in patients with psoriasis are not well described. Thus we sought to define the safety profile and effectiveness of ICIs in patients with pre-existing psoriasis.Methods In this retrospective cohort study, patients from eight academic centers with pre-existing psoriasis who received ICI treatment for cancer were evaluated. Main safety outcomes were psoriasis exacerbation and immune-related adverse events (irAEs). We also assessed progression-free survival (PFS) and overall survival.Results Of 76 patients studied (50 (66%) male; median age 67 years; 62 (82%) with melanoma, 5 (7%) with lung cancer, 2 (3%) with head and neck cancer, and 7 (9%) with other cancers; median follow-up 25.1 months (range=0.2–99 months)), 51 (67%) received anti-PD-1 antibodies, 8 (11%) anti-CTLA-4, and 17 (22%) combination of anti-PD-1/CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (46 patients (61%)) and 15 (20%) with psoriatic arthritis. Forty-one patients (54%) had received any prior therapy for psoriasis although only two (3%) were on systemic immunosuppression at ICI initiation. With ICI treatment, 43 patients (57%) experienced a psoriasis flare of cutaneous and/or extracutaneous disease after a median of 44 days of receiving ICI. Of those who experienced a flare, 23 patients (53%) were managed with topical therapy only; 16 (21%) needed systemic therapy. Only five patients (7%) required immunotherapy discontinuation for psoriasis flare. Forty-five patients (59%) experienced other irAEs, 17 (22%) of which were grade 3/4. PFS with landmark analysis was significantly longer in patients with a psoriasis flare versus those without (39 vs 8.7 months, p=0.049).Conclusions In this multicenter study, ICI therapy was associated with frequent psoriasis exacerbation, although flares were manageable with standard psoriasis treatments and few required ICI discontinuation. Patients who experienced disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy.No data are available. All data relevant to the study are included in the article or uploaded as supplemental information. ER -