The following is a summary of “Safety and Efficacy of Immune Checkpoint Inhibitors in Cancer Patients and Preexisting Autoimmune Disease: A Systematic Review and Meta-Analysis in Non–Small-Cell Lung Cancer,” published in the November 2023 issue of Pulmonology by Aung, et al.

People with cancer who already have autoimmune diseases (AID) have not been able to take part in clinical studies of immune checkpoint inhibitors (ICI) because of safety issues. As the uses of ICI grow, more information is needed on how safe and effective it is for treating cancer in people with AIDS. For a study, researchers carefully looked for studies that included NSCLC, AID, ICI, drug reactions, and bad events. Some outcomes that are worth looking at are the number of autoimmune flares, irAEs, reaction rates, and people stopping ICI. Random-effects meta-analysis was used to combine the study results. The data came from 24 cohort studies with 11,567 cancer patients (3,774 with NSCLC and 1,115 with AID). 

The overall rate of AID flare-ups was 36% (95% CI: 27%–46%) in all cancers and 23% (95% CI: 9%–40%) in NSCLC. Having AID before was linked to a higher chance of developing irAE in all cancer patients (RR 1.38, 95% CI, 1.16–1.65) and non-small cell lung cancer patients (RR 1.51, 95% CI, 1.12-2.03). In cancer patients with and without AID, there was no change in the de novo grade 3 to 4 irAE rate or cell death. 

People with NSCLC who already had AID had a twofold higher risk of getting grade 3 to 4 irAE (RR 1.95, 95% CI, 1.01-3.75), but they were also more likely to get a complete or partial response to treatment (RR 1.56, 95% CI, 1.19–2.04). People with NSCLC who already have AIDS are more likely to get grade 3 to 4 irAE, but they are also more likely to respond to treatment. To improve results for NSCLC patients with AIDS, prospective studies needed to be done to find the best immunotherapeutic methods.

Source: sciencedirect.com/science/article/abs/pii/S1525730423001080