A question we often get when a person is contemplating immunotherapy for their cancer is, “What if I have an autoimmune disease?” Autoimmune diseases occur when immune cells start attacking healthy cells. Having an autoimmune disease typically disqualifies someone for an immunotherapy clinical trial. The concern is that an immunotherapy would worsen an autoimmune disease and wreak havoc on the patient. But a new retrospective study, presented at the American Society of Clinical Oncology (ASCO) 2016 Annual Meeting, gives patients hope that they can be on an immunotherapy despite having an autoimmune disease.
Some common autoimmune disorders are:
- rheumatoid arthritis, which affects the joints, including the hands and feet
- lupus, which affects the skin, joints, kidney, and brain
- celiac disease, where one has a reaction to eating gluten, a protein found in wheat, barley, and rye
- psoriasis, a skin condition that causes redness and irritation, as well as thick, flaky, silver-white patches
- type 1 diabetes, which causes destruction of the insulin-producing cells in the pancreas
The study included 119 melanoma patients, who had preexisting autoimmune diseases and/or major immune-related side effects with prior ipilimumab (Yervoy®) treatment and who received either pembrolizumab (Keytruda®) or nivolumab (Opdivo®), two anti-PD-1 antibodies. The study found that treatment with immunotherapy was safe, with only 16 patients having to stop the treatment because of the side effects. The overall response rate was also very good, with 33% of patients with autoimmune disease and 40% of patients with immune-related side effects with ipilimumab responding to treatment.
This study also suggested that these results may be applied for all types of cancer, including lung, kidney, and bladder cancers.
The clinicians are doing an extension study to evaluate eligibility for clinical trials. When it is done—assuming the results correspond with these results here—a lot more patients will be able to receive an immune-based drug, despite having an autoimmune disease. That’s great news.
CRI scientists Antoni Ribas, M.D., Ph.D., of the UCLA Medical Center, and Georgina V. Long, Ph.D., M.B.B.S., of the Melanoma Institute of Australia and University of Sydney, took part in this important study.
If you want to know more about autoimmunity and immunotherapy, watch our “Ask a Scientist” video here.