Autoimmune antibodies predict clinical benefit, adverse events in NSCLC
medwireNews: The presence of some autoimmune antibodies prior to treatment with programmed cell death protein 1 (PD-1) inhibitors is associated with both clinical benefit and immune-related adverse events (irAEs) in patients with non-small-cell lung cancer (NSCLC), researchers report.
Shunichi Sugawara and colleagues from Sendai Kousei Hospital in Japan say that detecting pre-existing rheumatoid factor, antinuclear antibodies, or antithyroid antibodies “may help determine the risk-benefit ratio for individual patients with non-small cell lung cancer, maximizing therapeutic benefits while minimizing immune-related adverse events.”
The findings are based on a review of medical records from 137 patients with subclinical advanced NSCLC who received nivolumab (72%) or pembrolizumab (28%) monotherapy between January 2016 and January 2018.
Over half (58%) of the patients were positive for least one autoimmune antibody prior to anti-PD-1 treatment, with 28%, 35%, and 18% having rheumatoid factor, antinuclear antibodies, and antithyroid antibodies, respectively.
As reported in JAMA Oncology, patients with pre-existing antibodies had a significantly higher objective response rate and disease control rate than those without, at 41% versus 18% and 81% versus 54%, respectively.
Median progression-free survival (PFS) was also significantly longer among those with versus without pre-existing antibodies, at 6.5 versus 3.5 months.
The researchers note that this difference was primarily driven by a significant difference in median PFS among patients with versus without rheumatoid factor, at 10.1 and 3.7 months, respectively, as there were no significant differences observed between patients with or without pre-existing antinuclear or antithyroid antibody.
Just under half (48%) of patients developed irAEs, most commonly skin reactions (64%), hypothyroidism (23%), and pneumonitis (21%).
Patients with pre-existing antibodies were a significant 3.25 times more likely to develop irAEs of any-grade than those without, at rates of 60% versus 32%, but adverse events of grade 3 or higher were similar between the groups.
Skin reactions were reported significantly more often among patients with than without pre-existing rheumatoid factor (47 vs 24%), whereas hypothyroidism was significantly more common among those with than without pre-existing antithyroid antibodies (20 vs 1%).
Rates of pneumonitis, hepatitis, and myositis or peripheral neuropathy, however, were similar across all groups.
Sugawara and co-authors believe that “identifying the predictors or factors associated with irAEs is important” because careful management of such events “can facilitate achieving the maximum clinical benefit from nivolumab or pembrolizumab monotherapy.”
By Laura Cowen
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