A multicenter analysis of the outcome of cancer patients with neutropenia and COVID-19 infection optionally treated with granulocyte colony-stimulating factor (G-CSF).

12105 Background: Infection by SARS-CoV-2 can turn into an acute respiratory infection. Approximately 15% of patients will develop a distress syndrome responsible in most cases of mortality. A host hyperinflammatory response induced by a cytokine storm, is the main cause of this severe complication. Chemotherapy myelosuppression is associated with higher risk of infections and mortality in cancer patients. There have been no previous reports about the clinical management of patients with neutropenia and concomitant COVID-19. Herein, we present a multicenter experience in several hospitals during COVID-19 outbreak in neutropenic cancer patients infected by SARS-Cov-2. Methods: Retrospective clinical data were collected from clinical reports. Protocol was approved by a Clinical Research Ethics Committee (HULP: PI-4194). Inclusion criteria were cancer patients with neutropenia (<1500 cells/mm3) and concomitant COVID-19 infection. Comorbidities, tumor type and stage, treatment, neutropenia severity, filgrastim (G-CSF), COVID-19 parameters and mortality were analyzed. Exploratory analysis included a description of all data collected and bivariate analyses among different pairs of variables, including their impact in mortality in this cohort. In addition, multivariable logistic regression was used to predict respiratory failure and death as a function of multiple variables. Results: Among 943 patients with cancer screened in 14 hospitals in Spain, eighty-three patients (8%) had a febrile neutropenia and COVID-19 infection. Lung (26%), breast (22%), colorectal (13%) and digestive non-colorectal (17%) cancers were the main locations and most patients had advanced disease (67%). Fifty-three (63%) of patients included died because respiratory failure. Neumonia was presented in 76% of patients, bilateral in 47% and 12% of all patients had thrombotic events. The median of neutrophils was 650cls/mm3 and 49% received G-CSF with a median of days on treatment around 4,5 days. Among all variables related with mortality in neutropenic cancer patients with COVID-19 infection, we found that the number of days with G-CSF showed a significant trend toward worse outcome and higher mortality. In particular, a logistic regression model was developed to predict respiratory failure, as a function of the number of days of G-CSF treatment. As adjusting covariates, sex, age, treatment purpose (palliative vs curative, to adjust for patient status), tumor type, and the lowest level of neutrophils in the patient (to adjust for neutropenic status) were used. A significant effect was obtained for the days of G-CSF treatment (OR = 1.4, 95% CI [1.03, 1.92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with COVID-19, with a higher probability of worse outcome.

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A Multicenter Analysis of the Outcome of Cancer Patients with Neutropenia and COVID-19 Optionally Treated with Granulocyte-Colony Stimulating Factor (G-CSF): A Comparative Analysis

Cancers ◽

10.3390/cancers13164205 ◽

2021 ◽

Vol 13 (16) ◽

pp. 4205

Author(s):

María Sereno ◽

Ana María Jimenez-Gordo ◽

Javier Baena-Espinar ◽

Carlos Aguado ◽

Xabier Mielgo ◽

...

Keyword(s):

Cancer Patients ◽

Logistic Model ◽

Distress Syndrome ◽

Bivariate Analysis ◽

P Value ◽

Tumor Type ◽

Multicenter Analysis ◽

Support Methods ◽

The Impact ◽

Stimulating Factor

Background: Approximately 15% of patients infected by SARS-CoV-2 develop a distress syndrome secondary to a host hyperinflammatory response induced by a cytokine storm. Myelosuppression is associated with a higher risk of infections and mortality. There are data to support methods of management for neutropenia and COVID-19. We present a multicenter experience during the first COVID-19 outbreak in neutropenic cancer patients infected by SARS-CoV-2. Methods: Clinical retrospective data were collected from neutropenic cancer patients with COVID-19. Comorbidities, tumor type, stage, treatment, neutropenia severity, G-CSF, COVID-19 parameters, and mortality were analyzed. A bivariate analysis of the impact on mortality was carried out. Additionally, we performed a multivariable logistic regression to predict respiratory failure and death. Results: Among the 943 cancer patients screened, 83 patients (11,3%) simultaneously had neutropenia and an infection with COVID-19. The lungs (26%) and breasts (22%) were the primary locations affected, and most patients had advanced disease (67%). In the logistic model, as adjusted covariates, sex, age, treatment (palliative vs. curative), tumor type, and the lowest level of neutrophils were used. A significant effect was obtained for the number of days of G-CSF treatment (OR = 1,4, 95% CI [1, 1, 03, 92], p-value = 0.01). Conclusions: Our findings suggest that a prolonged G-CSF treatment could be disadvantageous for these cancer patients with infections by COVID-19, with a higher probability of worse outcome.

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Cancer Patients at Risk for Medication-Related Osteonecrosis of the Jaw. A Case and Control Study Analyzing Predictors of MRONJ Onset

Journal of Clinical Medicine ◽

10.3390/jcm10204762 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4762

Author(s):

Antonia Marcianò ◽

Ylenia Ingrasciotta ◽

Valentina Isgrò ◽

Luca L’Abbate ◽

Saveria Serena Foti ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Logistic Regression ◽

Regression Analysis ◽

Zoledronic Acid ◽

Cancer Patients ◽

Logistic Regression Analysis ◽

Osteonecrosis Of The Jaw ◽

P Value ◽

Multiple Variables

The goal of this investigation was to identify potential risk factors to predict the onset of medication-related osteonecrosis of the jaw (MRONJ). Through the identification of the multiple variables positively associated to MRONJ, we aim to write a paradigm for integrated MRONJ risk assessment built on the combined analysis of systemic and local risk factors. The characteristics of a cohort of cancer patients treated with zoledronic acid and/or denosumab were investigated; beyond the set of proven risk factors a new potential one, the intake of new molecules for cancer therapy, was addressed. Registered data were included in univariate and multivariate logistic regression analysis in order to individuate significant independent predictors of MRONJ; a propensity score-matching method was performed adjusting by age and sex. Univariate logistic regression analysis showed a significant effect of the parameters number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.05; p = 0.008) and chemotherapy (OR = 0.35; 95% CI = 0.17–0.71; p = 0.008). The multiple logistic regression model showed that breast, multiple myeloma, and prostate cancer involved a significantly higher risk compared to lung cancer; a significant effect of the combined variables number of doses of zoledronic acid and/or denosumab (OR = 1.03; 95% CI = 1.01–1.06); p-value = 0.03) and exposure to novel molecule treatment (OR = 34.74; 95% CI = 1.39–868.11; p-value = 0.03) was observed. The results suggest that a risk assessment paradigm is needed for personalized prevention strategies in the light of patient-centered care.

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The Effect of Neutropenia and Filgrastim (G-CSF) in Cancer Patients With COVID-19 Infection

10.1101/2020.08.13.20174565 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sejal Morjaria ◽

Allen Zhang ◽

Anna Kaltsas MD ◽

Rekha Parameswaran ◽

Dhruvkumar Patel ◽

...

Keyword(s):

Respiratory Failure ◽

Growth Factor ◽

Cancer Patients ◽

Cox Model ◽

Cancer Center ◽

P Value ◽

Proliferation And Differentiation ◽

Observational Cohort ◽

Stimulating Factor ◽

Extended Cox Model

Background: Neutropenia is commonly encountered in cancer patients, and recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim) is widely given to oncology patients to counteract neutropenia and prevent infection. G-CSF is both a growth factor and cytokine that initiates proliferation and differentiation of mature granulocytes. However, the clinical impact of neutropenia and G-CSF use in cancer patients, who are also afflicted with coronavirus disease 2019 (COVID-19), remains unknown. Methods: An observational cohort of 304 hospitalized patients with COVID-19 at Memorial Sloan Kettering Cancer Center was assembled to investigate links between concurrent neutropenia (N=55) and G-CSF administration (N=16) on COVID-19-associated respiratory failure and death. These factors were assessed as time-dependent predictors using an extended Cox model, controlling for age and underlying cancer diagnosis. To determine whether the degree of granulocyte response to G-CSF affected outcomes, a similar model was constructed with patients that received G-CSF, categorized into high- and low-response, based on the level of absolute neutrophil count (ANC) rise 24 hours after growth factor administration. Results: Neutropenia (ANC < 1 K/mcL) during COVID-19 course was not independently associated with severe respiratory failure or death (HR: 0.71, 95% Cl: 0.34-1.50, P value: 0.367) in hospitalized COVID-19 patients. When controlling for neutropenia, G-CSF administration was associated with increased need for high oxygen supplementation and death (HR: 2.97, 95% CI: 1.06-8.28, P value: 0.038). This effect was predominantly seen in patients that exhibited a high response to G-CSF based on their ANC increase post-G-CSF administration (HR: 5.18, 95% CI: 1.61-16.64, P value: 0.006). Conclusion: Possible risks versus benefits of G-CSF administration should be weighed in neutropenic cancer patients with COVID-19 infection, as G-CSF may lead to worsening clinical and respiratory status in this setting.

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Hubungan Perilaku Caring Perawat Dengan Tingkat Harapan Sembuh Pada Pasien Kanker Yang Menjalani Program Kemoterapi Di Rumah Sakit Baladhika Husada Jember

Buletin Penelitian Sistem Kesehatan ◽

10.22435/hsr.v23i3.3123 ◽

2020 ◽

Vol 23 (3) ◽

pp. 169-177

Author(s):

Alvinda Apriliatul Jannah ◽

Anisah Ardiana ◽

Retno Purwandari

Keyword(s):

Social Support ◽

Cancer Patients ◽

Cross Sectional Study ◽

Patient Comfort ◽

P Value ◽

Cross Sectional ◽

Patients With Cancer ◽

Caring Behavior ◽

Nurse Caring ◽

The Relationship

Hope is a crucial issue in patients with cancer. Hope can be increased by providing social support. Social support can be obtained from the nurses caring behavior. This research aimed to analyze the relationship between nurses caring behavior and recovery hope level of cancer patients undergoing chemotherapy program at Baladhika Husada Hospital in Jember. A cross-sectional study was conducted to 112 respondents using the Caring Behavior Inventory (CBI-24) questionnaire and Scale of Hope. The data were analyzed applying the Kendall Tau B (τ) correlation. The results showed that there was a relationship between nurses caring behavior with the level of recovery expectancy of cancer patients undergoing chemotherapy programs at Baladhika Husada Hospital in Jember (p-value <0.001; τ = 0.375). Nurse caring behavior increases patient comfort and makes patients more enthusiastic about undergoing therapy. Patients feel valued and get more information from nurses. Therefore, the patient's recovery hopes can increase. This study concludes that nurses caring behavior can increase the expectation of recovery of cancer patients. Abstrak Harapan adalah hal krusial pada pasien kanker. Harapan dapat ditingkatkan dengan pemberian dukungan sosial yang bisa didapat dari perilaku caring perawat. Tujuan dari penelitian ini adalah untuk menganalisis hubungan perilaku caring perawat dengan tingkat harapan sembuh pasien kanker yang menjalani program kemoterapi di Rumah Sakit Baladhika Husada Jember. Penelitian ini menggunakan metode cross sectional dan 112 responden didapatkan dengan teknik sampel purposive samping. Data didapatkan melalui kuesioner CBI-24 dan kuesioner skala harapan. Analisis pada penelitian ini menggunakan uji korelasi Kendall Tau B (τ). Hasil menunjukkan terdapat hubungan antara perilaku caring perawat dengan tingkat harapan sembuh pasien kanker yang menjalani program kemoterapi di Rumah Sakit Baladhika Husada Jember (p value < 0,001; τ = 0,375). Perilaku caring perawat dapat meningkatkan kenyamanan pasien dan membuat pasien lebih semangat menjalankan terapi yang dijalani. Pasien merasa dinilai dan mendapatkan informasi lebih dari perawat. Maka dari itu, harapan sembuh pasien dapat meningkat. Kesimpulan dari penelitian ini adalah perilaku caring perawat dapat meningkatkan harapan sembuh pasien kanker.

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Acute Non-Infectious Complications of Pediatric Hematopoietic Stem Cell Transplantation: An in-Hospital Nationwide Study in the United States from 2001-2019

Blood ◽

10.1182/blood-2020-139715 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 32-32

Author(s):

Maria Alejandra Pereda ◽

Sindhoosha Malay ◽

Jignesh Dalal

Keyword(s):

Mechanical Ventilation ◽

Logistic Regression ◽

Stem Cell ◽

Respiratory Failure ◽

Hematopoietic Stem Cell Transplantation ◽

Infectious Complications ◽

P Value ◽

Early Complications ◽

Hematopoietic Stem ◽

Icu Admission

Introduction Hematopoietic stem cell transplantation (HSCT) is an effective treatment for malignant and non-malignant disorders and may be the only curative option for some diseases. Although overall outcomes of HSCT in pediatrics have improved HSCT is still associated with high morbidity and mortality. Toxicity following HSCT can virtually affect any organ and occur at different steps in the process. Early complications are to occur in the first 100 days post transplant. In this study we aimed to describe the frequency of early complications following HSCT and possible risk factors associated with increased ICU care and mortality. Methods With IRB approval, the Pediatric Health Information Systems (PHIS) database was queried to analyze information of all HSCT performed admitted between January 2001 and December 2019. The PHIS database is a comprehensive pediatric database that includes inpatient encounters for more than 52 children's hospitals. We extracted relevant ICD-9 and 10 diagnoses, procedure codes, and medications for each patient related to toxicities as outlined by the NCI. For Sinusoidal obstructive syndrome, graft failure and posterior reversible encephalopathy syndrome only ICD 10 code were reported. Clinical characteristics, demographics, procedures and medication of patients were presented using frequency and percentages for categorical variables with a Chi-square p-value (comparisons by ICU admission and Mortality). Univariate and multivariate logistic regression was performed with 'discharge mortality' and 'ICU admission' as primary outcomes. P-value of less than 0.05 or absence of 1 in the 95% confidence intervals was considered statistically significant. All statistical analyses were performed using SAS software, version 9.4 (SAS Institute, Cary, NC) and R software, version 4.0.0. Results A total of 13,538 patients met primary inclusion criteria of HSCT. Of these 6,938 transplants (51.2%) were performed to treat a malignant condition. 95.4% of these transplants were allogeneic and most of them performed within 2011 to 2019 (63.4%). Adolescents and Young adults accounted for 18.3% of patients and 8% of all HSCT patients passed away. The most common conditioning regimen reported was Busulfan and Cyclophosphamide (21.04%) and the most used GVHD prophylaxis was Methotrexate and Tacrolimus (21.1%). Common complications reported were acute kidney injury (14%), respiratory failure (12.8%) and acute GVHD (10%). From the patients that developed respiratory failure 90.5% were in the ICU, 80.9% required Mechanical ventilation and 49.6% died. 239 patients developed sinusoidal obstructive syndrome with 67.4% requiring ICU and 20.5% mortality. Defibrotide was used in 60.3% of these patients. Table 1 and 2 describe our findings and statistically significant results for ICU admission and discharge mortality. Logistic regression and multivariate analysis showed increased ICU admission and discharge mortality in AYA patients (OR 1.36, CI 1.20-1.53, p<.0001 and OR 1.29, CI 1.03-1.64, p<0.03, respectively). From 2009 to 2019 there is an increased OR for ICU admission post HSCT but significant decreased in discharge mortality. Mechanical ventilation was the strongest predictor for ICU admission and discharge mortality (OR 44.81, CI = 37.19-53.99, p<.0001 and OR 31.23, CI = 23.57 - 41.38, p<.0001, respectively), followed by dialysis (OR 5.74, CI = 3.98-8.27, p<.0001 and OR 5.82, CI = 4.62-7.32, p<.0001). Patients diagnosed with sinusoidal obstructive syndrome had 3.2 times OR for ICU (CI = 2.29-4.57, p<.0001) but decreased OR for mortality (OR 0.62, CI 0.39-0.98, p=0.038). SCID and Mucopolysaccharidosis patients had increased OR for ICU admission but not for discharge mortality. Conclusion To our knowledge this is the largest multicenter database analysis describing acute non-infectious complications of pediatric HSCT. Survival of HSCT patients that developed SOS have improved since 2016 which may be reflecting the introduction of Defibrotide. Mechanical ventilation was the strongest predictor for mortality with almost 30 times increased in odds ratio. Mucopolysaccharidosis and SCID showed increased need for ICU care but decreased mortality suggesting improvement in intensive care unit management. Prospective studies are needed to better describe outcomes of HSCT patients as well as areas of possible improvement to increase overall survival. Disclosures No relevant conflicts of interest to declare.

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Sarcoma Does Not Predict Malnutrition in Cancer Patients: A Retrospective Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa055_016 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1131-1131

Author(s):

Nankun Liu ◽

Alexander Hien Vu ◽

David Seres ◽

Max Shen

Keyword(s):

Logistic Regression ◽

Cancer Patients ◽

Albumin Level ◽

T Test ◽

P Value ◽

Chi Square ◽

Global Test ◽

Hospital Malnutrition ◽

Increased Risk ◽

Using Data

Abstract Objectives The association between inflammation, malnutrition, and cancer is not well understood. The aim of this study was to examine the association between inflammatory-type cancer and diagnosed malnutrition, albumin level, and age in patients with cancer. Methods Malnutrition and cancer diagnoses were obtained using data from hospital medical records in patients admitted for cancer between Oct. 2017 and Dec. 2018. Demographics, as well as the first and lowest albumin levels were also obtained. A simple t-test is processed between age and malnutrition status. Also a chi-square test of independence was performed to examine the relation between malnutrition and hypoalbuminemia status. Logistic regression was conducted between malnutrition status, sarcoma cancer, age, and hypoalbuminemia. Results The study included 4034 patients (2084 males, 1949 females). Approximately 4% of the patients were diagnosed with malnutrition. Logistic regression on malnutrition status, sarcoma, age, and hypoalbuminemia showed a significant association on global test (3, 2433, P-value = 0.013). Hypoalbuminemia (< 3.9 g/dL lower-limit) was significantly associated with malnutrition (X2 1, 2433 P-value = 0.0156). Sarcoma diagnosis was not significantly associated with malnutrition (X2 1, 2433 P-value = 0.267). Age is not significantly related to malnutrition status (X2 1, 2433 p-value = 0.449). A t-test was also performed malnutrition vs no malnutrition on age, resulting in a marginally significant association for malnutrition group (M = 65.33, SD = 15.50) vs no malnutrition group (M = 67.32, SD = 17.55) (t(1) = 3.7212, P = 0.0537). Conclusions Sarcoma is not significantly associated with an increased risk of malnutrition. Cancer patients with hypoalbuminemia have a higher risk for malnutrition compared to the patients with normal albumin level. Additionally, age may be a predictor for cancer patients’ risk of in-hospital malnutrition. Funding Sources None.

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Pre- vs. Post-National Coverage Determination (NCD) Blood Utilization and Hemoglobin Values among Medicare Patients Treated with Erythropoietic-Stimulating Agents (ESAs) for Chemotherapy-Induced Anemia (CIA)

Blood ◽

10.1182/blood.v112.11.1301.1301 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1301-1301 ◽

Cited By ~ 1

Author(s):

Tanya Burton ◽

Kay Larholt ◽

Elizabeth Apgar ◽

Chris Pashos ◽

Brahim Bookhart ◽

...

Keyword(s):

Cancer Patients ◽

Clinical Trial Data ◽

Study Patient ◽

P Value ◽

Tumor Type ◽

Time Period ◽

Hospital Systems ◽

Utilization Patterns ◽

Blood Utilization ◽

The Impact

Abstract Background: In July 2007, the Centers for Medicare and Medicaid Services issued ESA coverage limitations for cancer patients with CIA through a national coverage determination (NCD). Clinical outcomes based on ESA dosing described in the NCD have not been reported in prospective observational or clinical trial data. To understand hematologic outcomes in the Medicare population treated in pre- and post-NCD time period, an analysis of hematologic outcomes from the DOSE (Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies) registry, an ongoing prospective observational study, was conducted. Methods: ESA-treated cancer patients with CIA were selected based on Medicare primary coverage, available baseline hemoglobin (Hb) value, and receipt of at least two ESA administrations. Data were categorized into two timeframes based on date of initial ESA administration: pre-NCD (4/06-4/07) and post-NCD (10/07-5/08). Baseline demographics, Hb values during ESA treatment, and blood utilization patterns were analyzed. Results: 288 patients were identified (Pre-NCD – 230; Post-NCD – 58) from 41 sites. Patient groups were similar with respect to age, gender, weight, and tumor type. ESA treatment duration was significantly greater in the pre-NCD group (70 days vs. 54 days, p = 0.0011). As shown in the table, differences with regard to blood utilization and Hb values were observed between the Pre-NCD and Post-NCD populations. A significantly greater proportion of patients required a blood transfusion and the number of units administered per study patient was significantly higher in the Post-NCD group. Hb levels were significantly lower at all time points of observation in the Post-NCD group. Pre-NCD Post-NCD p-value Transfusion Outcomes Proportion of Patients Transfused 18.3% 32.8% p = 0.0157 Mean No. of Units per Study Patient 0.5 1.1 p = 0.0089 Hematologic Outcomes: Mean Hb (SD) Baseline 10.6 (0.8) 9.6 (0.5) < 0.0001 Week 4 11.1 (1.3) 9.9 (1.1) < 0.0001 Week 8 11.2 (1.3) 10.4 (1.3) 0.013 Week 12 11.1 (1.3) 9.8 (1.2) 0.0002 Week 16 11.0 (1.1) 9.7 (0.2) 0.018 Conclusion: Greater blood utilization and lower Hb values were observed in Medicare CIA patients treated with ESAs during the Post-NCD time period compared to the Pre- NCD time period. The impact of the NCD on patient outcomes is important to providers and hospital systems and warrants further research.

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Oncologic immunomodulatory agents in patients with cancer and COVID-19

Scientific Reports ◽

10.1038/s41598-021-84137-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Justin Jee ◽

Aaron J. Stonestrom ◽

Sean Devlin ◽

Teresa Nguyentran ◽

Beatriz Wills ◽

...

Keyword(s):

Respiratory Failure ◽

Cancer Patients ◽

Supplemental Oxygen ◽

Cancer Center ◽

Corticosteroid Administration ◽

Patients With Cancer ◽

Hematologic Cancer ◽

Significant Difference ◽

Anti Cd20 ◽

Relative Prevalence

AbstractCorticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. It is unclear how these agents affect patients with cancer who are infected with SARS-CoV-2. We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N = 820). We controlled for cancer-related characteristics known to predispose to worse COVID-19 as well as level of respiratory support during corticosteroid administration. Corticosteroid administration was associated with worse outcomes prior to use of supplemental oxygen; no statistically significant difference was observed in sicker cohorts. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era.

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The Efficacy and Safety of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease

Frontiers in Oncology ◽

10.3389/fonc.2021.625872 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hui Tang ◽

Jianfeng Zhou ◽

Chunmei Bai

Keyword(s):

Autoimmune Disease ◽

Cancer Patients ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitor ◽

Checkpoint Inhibitors ◽

Treatment Options ◽

Close Monitoring ◽

Tumor Type ◽

Patients With Cancer ◽

High Benefit

Immune checkpoint inhibitor (ICI) is a revolutionary breakthrough in the field of cancer treatment. Because of dysregulated activation of the immune system, patients with autoimmune disease (AID) are usually excluded from ICI clinical trials. Due to a large number of cancer patients with preexisting AID, the safety and efficacy of ICIs in these patients deserve more attention. This review summarizes and analyzes the data regarding ICI therapy in cancer patients with preexisting AID from 17 published studies. Available data suggests that the efficacy of ICIs in AID patients is comparable to that in the general population, and the incidence of immune-related adverse events (irAEs) is higher but still manageable. It is recommended to administer ICIs with close monitoring of irAEs in patients with a possibly high benefit-risk ratio after a multidisciplinary discussion based on the patient’s AID category and severity, the patient’s tumor type and prognosis, alternative treatment options, and the patient’s intention. Besides, the prevention and management of irAEs in AID patients have been discussed.

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