Immune manifestations with checkpoint inhibitors in a single Brazilian center: experience and literature review

Abstract

Objectives:

The presence of autoimmune events were recorded in patients receiving immune checkpoint inhibitors.

Materials & Methods:

Retrospective study in patients receiving immune checkpoint inhibitors (ICIs) during the period of 2012–2019.

Results:

A total of 554 patients received ICIs of which 123 developed an immune related adverse event. Twenty one (17%) with toxicity were identified as having a pre-existing autoimmune disease and 88 required treatment with corticosteroids or hormone replacement. Thirty two (26%) out of 123 had to temporarily discontinue ICIs due to autoimmune manifestations. Endocrine and skin manifestations were the most prevalent immune disorders in our cohort. In melanoma better efficacy was seen in patients with immune toxicity.

Conclusion:

Autoimmune diseases appear in patients receiving ICIs in this real world experience. Our results differ from other series on the frequency of autoimmunity. Complete discontinuation of ICIs due to autoimmunity was rare.

Lay abstract

The development of autoimmune events in patients receiving the modern forms of cancer immunotherapy are not unexpected since the presence of robust immune response against tumors relies on mechanisms of T-cell activation and release of cytotoxic cytokines that can also mediate autoimmune inflammatory conditions. In fact, some studies including ours points to better efficacy against tumor in patients that also develop autoimmune toxicity. Cancer therapy has now five consolidated forms of treatment, Chemotherapy, Radiotherapy, Surgery Biologic Therapy and second generation Immunotherapy.