Abstract
BackgroundImmune checkpoint inhibitor (ICI) therapy has been described to markedly improve patient survival. However, reports describing the antitumor therapeutic efficacy and safety of ICIs in patients with autoantibodies are scarce.MethodsThis study examined the efficacy and feasibility of ICIs in antinuclear antibody (ANA)-positive patients with non-small cell lung cancer (NSCLC). An ANA titer greater than 1:40 and 1:80 was defined as positive and high, respectively. Patients who were treated with ICIs at Saitama Medical University, International Medical Center between January 2016 and December 2018 were retrospectively reviewed.ResultsOne hundred and nineteen of the 266 patients (44.7%) who received nivolumab, pembrolizumab, and atezolizumab had positive ANA titers. Their median age was 69 (range, 39–84) years. The overall response rate of the ANA-positive patients was 35.9% (37/103), which was not less than that of the ANA-negative group. The median progression-free survival in the ANA-positive group was 6.3 months versus 4.3 months in the ANA-negative group (p = 0.08). Twenty-seven ANA-positive patients (10.2%) had high ANA titers. However, ICI efficacy was not decreased in these patients. Regardless of the cutoff of ANA titers (1:40 or 1:80), the rate of patients who experienced adverse events were not significantly different between the two groups.ConclusionThe administration of ICIs to ANA-positive patients has clinical benefits. The prevalence of adverse events in the ANA-positive group was not higher than that in the ANA-negative group.
Highlights
Immune checkpoint inhibitors (ICIs) improve the survival of patients with advanced lung cancer [1,2,3,4]
All procedures performed were in accordance with the ethical standards of the Institutional Ethics Committee of Saitama Medical University, International Medical Center and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards
Epidermal growth factor receptor mutations were observed in 13 patients (10.9%) and rearrangement of anaplastic lymphoma kinase-echinoderm microtubule-associated protein-like 4 in 1 patient (0.8%)
Summary
Immune checkpoint inhibitors (ICIs) improve the survival of patients with advanced lung cancer [1,2,3,4]. The management of adverse events is a critical issue, and this needs to be done carefully for the maximum efficacy of ICIs to be obtained. To prevent unnecessary immune-related adverse events (irAEs), the patient’s autoantibodies are often examined prior to treatment. Khan et al reported that 13.5% of 210,509 patients with lung cancer had AIDs, and majority of the patients were females, elderly, and had early stage disease [8]. It is common to find lung cancer patients with AIDs. Immune checkpoint inhibitor (ICI) therapy has been described to markedly improve patient survival. Reports describing the antitumor therapeutic efficacy and safety of ICIs in patients with autoantibodies are scarce
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