Safety and efficacy of checkpoint inhibition in patients with melanoma and preexisting autoimmune disease

Dutch researchers investigated whether immune checkpoint inhibition (ICI) is a valid intervention for patients with advanced melanoma. Of 4,367 participants included in the cohort study, 415 had preexisting autoimmune disease (AID). Investigators compared outcomes after treatment with ICI, anti-cytotoxic T lymphocyte-associated protein 4 (CTLA-4), anti-programmed cell death 1 (PD-1), or combination therapy. Among patients with AID, immune-related adverse events (irAEs) of grade 3 or higher occurred at a rate of 30% for those who received anti-CTLA-4, 17% for those who received anti-PD-1, and 44% of those who underwent combination therapy. Among patients without AID, the corresponding percentages were 30%, 13%, and 48%, respectively. The findings revealed little difference in the overall incidence of severe irAEs or survival rates in patients with advanced melanoma, regardless of AID status. One result the researchers say bears further investigation is that patients with preexisting inflammatory bowel disease—a type of AID—were more likely to suffer colitis and toxicity severe enough to warrant early discontinuation of treatment.