El-Refai Sherif M, Brown Joshua D, Black Esther P, Talbert Jeffery C
Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, USA.
Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA.
Cancer Inform. 2017 Jun 1;16:1176935117712520. doi: 10.1177/1176935117712520. eCollection 2017.
Immune checkpoint inhibition reactivates the immune response against cancer cells in multiple tissue types and has been shown to induce durable responses. However, for patients with autoimmune disorders, their conditions can worsen with this reactivation. We sought to identify, among patients with lung and renal cancer, how many harbor a comorbid autoimmune condition and may be at risk of worsening their condition while on immune checkpoint inhibitors such as nivolumab and pembrolizumab.
An administrative health care claims database, Truven MarketScan, was used to identify patients diagnosed with lung and renal cancer from 2010 to 2013. We assessed patients for diagnosis of autoimmune diseases 1 year prior to or after diagnosis of cancer using codes for 41 autoimmune diseases. Baseline characteristics and other comorbid conditions were recorded.
More than 25% of patients with both lung and renal cancer had a comorbid autoimmune condition between 2010 and 2013 and were more likely to be women, older, and have more baseline comorbidities.
This population presents a dilemma to physicians when deciding to treat with immune checkpoint inhibitors and risk immune-related adverse events. Future evaluation of real-world use of immune checkpoint inhibitors in patients with cancer with autoimmune diseases will be needed.
免疫检查点抑制可重新激活针对多种组织类型癌细胞的免疫反应，并已显示能诱导持久反应。然而，对于患有自身免疫性疾病的患者，这种重新激活可能会使他们的病情恶化。我们试图在肺癌和肾癌患者中确定有多少人合并有自身免疫性疾病，以及在使用纳武单抗和派姆单抗等免疫检查点抑制剂治疗时，他们的病情可能有恶化风险。
使用一个医疗保健管理索赔数据库Truven MarketScan，来识别2010年至2013年期间被诊断为肺癌和肾癌的患者。我们使用41种自身免疫性疾病的编码，评估患者在癌症诊断前或诊断后1年内是否患有自身免疫性疾病。记录患者的基线特征和其他合并症情况。
在2010年至2013年期间，超过25%的肺癌和肾癌患者合并有自身免疫性疾病，而且这些患者更有可能是女性、年龄较大，并且有更多的基线合并症。
在决定使用免疫检查点抑制剂治疗并面临免疫相关不良事件风险时，这一人群给医生带来了两难困境。未来需要对患有自身免疫性疾病的癌症患者使用免疫检查点抑制剂的实际情况进行评估。
