Key takeaways:
- Sufferers with rheumatoid arthritis who obtain immune checkpoint inhibition for metastatic lung most cancers have related survival vs. these with out RA.
- These with RA “ought to be supplied” checkpoint remedy.
Sufferers with rheumatoid arthritis who endure immune checkpoint inhibition for metastatic non-small cell lung most cancers reveal related general survival as these with out RA, in accordance with knowledge printed in Arthritis Care & Analysis.
“Immune checkpoint inhibitors (ICIs) have dramatically modified most cancers remedy in the previous few years,” Deanna P. Jannat-Khah, DrPH, MSPH, of Hospital for Particular Surgical procedure and Weill Cornell Medication, informed Healio. “Nevertheless, sufferers with preexisting situations, like rheumatoid arthritis, had been excluded from the seminal scientific trials for these therapies. Beforehand printed research have proven quite a lot of impacts relating to ICI remedy in RA, from sufferers with RA having higher general survival to some reporting that RA sufferers have related survival to non-RA sufferers.
“Nevertheless, all these earlier research had severe methodological flaws, together with combining a number of various kinds of most cancers collectively and/or combining a number of varieties of autoimmune illness collectively, and even having a small variety of sufferers to review,” she added. “We purposely designed our research to make use of the biggest quantity of knowledge doable through the use of a real-world dataset to review one most cancers — non small cell lung most cancers — one autoimmune situation — RA — and one stage of most cancers — metastatic — to research if RA sufferers handled with ICI had higher general survival in comparison with non-RA sufferers.”
To match the general survival amongst sufferers with and with out RA receiving ICI remedy for stage 4 non-small cell lung most cancers, Jannat-Khah and colleagues performed a retrospective cohort research of Medicare claims knowledge. The researchers analyzed knowledge from 2,732 sufferers aged 66 years and older who had been recognized with “a malignant neoplasm of lung and bronchus,” and had began nivolumab (Opdivo, Bristol Myers Squibb), pembrolizumab (Keytruda, Merck) or atezolizumab (Tecentriq, Genentech/Roche) between March 4, 2015, and April 11, 2019.
This date vary coated the time after the FDA had authorized ICIs for metastatic non-small cell lung most cancers, however earlier than the primary approval for stage 3 illness.
Among the many included sufferers, 790 demonstrated pre-existing RA. The researchers used Kaplan Meier and adjusted Cox Proportional Hazard fashions to evaluate survival.
In keeping with the researchers, each the Kaplan Meier survival curves (log-rank P-value = .08) and the adjusted fashions (HR = 0.92; 95 CI, 0.78-1.09) urged there was no distinction in general survival between sufferers with RA and people with out.
Sufferers with RA had been extra more likely to be girls and demonstrated extra comorbidities, the researchers wrote. Amongst sufferers with RA, 63% had been receiving steroids, in contrast with 45% for these with out RA. Nevertheless, the 2 teams had been simply as more likely to be receiving dexamethasone — 27% vs. 28%, respectively — earlier than ICI remedy.
Male intercourse, extra comorbidities and steroid use previous to ICI remedy predicted worse general survival, in accordance with the researchers. Nevertheless, in a sensitivity evaluation excluding sufferers utilizing dexamethasone at baseline, steroid use previous to ICI remedy was now not related to worse survival.
“Total, we discovered no distinction in general survival between RA sufferers handled with ICI for non-small cell lung most cancers and non-RA sufferers,” Jannat-Khah stated. “Oral steroid dose was related to worse general survival, nonetheless it depends upon the kind of oral steroid. Dexamethasone is usually prescribed for most cancers palliation at doses which are a lot larger and extra frequent than different oral steroids prescribed to deal with RA signs. In a sensitivity evaluation, we excluded sufferers who had dexamethasone prescribed and located that steroid dose was now not related to worse general survival.
“RA sufferers with metastatic non-small cell lung most cancers can obtain and ought to be supplied ICI remedy, as general survival was related between RA and non-RA teams,” she added. “Steroid dose and kind of steroid — eg, dexamethasone — could also be related to general survival. Dexamethasone may very well be a proxy for extra superior illness and poor survival outcomes, as it’s generally prescribed for most cancers palliation.”
For extra data:
Healio Rheumatology could be reached at rheumatology@healio.com.
Sources/Disclosures
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Disclosures:
This research was funded by the Hospital for Particular Surgical procedure’s Division of Medication Discovery Grant. Jannat-Khah studies inventory or inventory choices in Cytodyn and Astrazeneca. Please see the research for added researchers’ disclosures.
