RT Journal Article
SR Electronic
T1 Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy
JF Journal for ImmunoTherapy of Cancer
JO J Immunother Cancer
FD BMJ Publishing Group Ltd
SP e003066
DO 10.1136/jitc-2021-003066
VO 9
IS 10
A1 Briana Rose Halle
A1 Allison Betof Warner
A1 Farzana Y Zaman
A1 Andrew Haydon
A1 Prachi Bhave
A1 Anna K Dewan
A1 Fei Ye
A1 Rebecca Irlmeier
A1 Paras Mehta
A1 Nicholas R Kurtansky
A1 Mario E Lacouture
A1 Jessica C Hassel
A1 Jacob S Choi
A1 Jeffrey A Sosman
A1 Sunandana Chandra
A1 Tracey S Otto
A1 Ryan Sullivan
A1 Meghan J Mooradian
A1 Steven T Chen
A1 Florentia Dimitriou
A1 Georgina Long
A1 Matteo Carlino
A1 Alexander Menzies
A1 Douglas B Johnson
A1 Veronica M Rotemberg
YR 2021
UL http://jitc.bmj.com/content/9/10/e003066.abstract
AB 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.