Tolerability of immune checkpoint inhibitors in patients with cancer and pre-existing multiple sclerosis

Abstract

In the last 10 years, immune checkpoint inhibitor (ICI) immunotherapies have become a pivotal treatment in many types of cancer and the management of immune-related adverse events is now well codified [ [1] Schneider B.J. Naidoo J. Santomasso B.D. Lacchetti C. Adkins S. Anadkat M. et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol. 2021; 39: 4073-4126 Crossref PubMed Scopus (284) Google Scholar ]. At the beginning of ICI utilisation, patients with a history of autoimmune diseases were initially contraindicated to receive ICI, subsequently safety data accumulated in favour of using ICI in patients with controlled and inactive autoimmune diseases [ 2 Michot J.M. Lappara A. Le Pavec J. Simonaggio A. Collins M. De Martin E. et al. The 2016-2019 ImmunoTOX assessment board report of collaborative management of immune-related adverse events, an observational clinical study. Eur J Cancer. 2020; 130: 39-50 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar , 3 Naidoo J. Zhang J. Lipson E.J. Forde P.M. Suresh K. Moseley K.F. et al. A multidisciplinary toxicity team for cancer immunotherapy-related adverse events. J Natl Compr Canc Netw. 2019; 17: 712-720 Crossref PubMed Scopus (54) Google Scholar ]. A risk of usually mild autoimmune flare (up to 75%) is reported in patients with autoimmune diseases such as rheumatoid arthritis, polymyalgia rheumatica, psoriatic arthritis and autoimmune colitis, after initiation of ICI [ [4] Tison A. Garaud S. Chiche L. Cornec D. Kostine M. Immune-checkpoint inhibitor use in patients with cancer and pre-existing autoimmune diseases. Nat Rev Rheumatol. 2022; 18: 641-656 Crossref PubMed Scopus (9) Google Scholar ], however the level of this flare risk remains unknown for multiple sclerosis (MS).