2023-11-07 12:35:37
Although ICIs have enabled considerable progress in oncology, they are also associated with potentially severe immune-induced adverse effects (IIII). What regarding patients already suffering from inflammatory pathologies before treatment? Few of these patients have been included in clinical trials. And although studies have not indicated increased mortality so far, the toxicity of these drugs remains poorly understood in this population. Using data from an international cohort of patients who received ICIs, an American team evaluated the association between the pre-existence of an inflammatory disease and the immune-induced cutaneous adverse effects that are most frequently found with ICIs. HERE. Its results were the subject of a pre-print publication (not yet peer-reviewed) in the Journal of the American Academy of Dermatology.
A risk of skin toxicity increased by 56% in the event of a pre-existing inflammatory skin disease
Of 3,607 patients who received ICIs, 37.5% had a pre-existing inflammatory disease, and 18.6% developed cutaneous IEs.
Multivariate analysis showed that those with pre-existing inflammatory disease had a 20% increased risk of developing cutaneous EIII (HR 1.2 [1,01-1,42] ; p=0.036) compared to those who were unaffected. This excess risk was even more marked (+56%) for patients who suffered from a pre-existing inflammatory skin disease (HR 1.56 [1,25-1,94] ; p<0,001), alors qu’il était inexistant pour ceux souffrant d’une maladie inflammatoire non cutanées.
This risk is potentiated when several inflammatory pathologies govern the treatment.
However, having both a pre-existing non-cutaneous and cutaneous inflammatory disease increased (+76%) the risk of cutaneous EIII (HR 1.76 [1,28-2,42] ; p<0,001). Et si la pathologie inflammatoire préexistante était dermatologique, le risque de toxicité cutanée s’était accru de façon significative (×3,6 pour la dermatite atopique, ×3,2 pour la sclérodermie localisée, ×1,8 pour le psoriasis).
In addition, the presence of a pre-existing cutaneous or non-cutaneous inflammatory pathology was associated with a risk of more severe skin toxicity of ICIs, a risk which was also increased in the event of the concomitant presence of a cutaneous and non-cutaneous MIp. Skin toxicities appeared earlier following initiation of treatment in subjects who suffered from cutaneous MIp vs Non-cutaneous MIp.
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