Sorting Out the Complexities of Autoimmunity and Checkpoint Inhibitors: Not So Easy
Authors: Leonard H. Calabrese
Journal: Annals of Internal Medicine (2018)

Editorials16 January 2018Sorting Out the Complexities of Autoimmunity and Checkpoint Inhibitors: Not So EasyLeonard H. Calabrese, DOLeonard H. Calabrese, DOCleveland Clinic Foundation, Cleveland, Ohio (L.H.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3079 Annals Author Insight Video - Leonard H. Calabrese, DO In this video, Leonard H. Calabrese, DO, offers additional insight into the article, "Sorting Out the Complexities of Autoimmunity and Checkpoint Inhibitors: Not So Easy." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical use of checkpoint inhibitor (CPI) therapy for cancer has grown rapidly; there are currently 6 approved agents that are increasingly used for a broad array of tumors. These drugs seem to hold the potential for durable response rates in patients with advanced disease and are not classically immunosuppressive in the vein of traditional, nontargeted chemotherapeutic agents (1). Immunologically, CPIs target several ligands found largely on T cells. These ligands normally dampen ongoing T-cell responses and physiologically serve to protect the host under conditions of chronic antigen exposure in order to limit collateral damage during a chronic and ongoing immune ...References1. Wolchok JD. PD-1 blockers. Cell. 2015;162:937. [PMID: 26317459] doi:10.1016/j.cell.2015.07.045 CrossrefMedlineGoogle Scholar2. Calabrese L, Velcheti V. Checkpoint immunotherapy: good for cancer therapy, bad for rheumatic diseases [Editorial]. Ann Rheum Dis. 2017;76:1-3. [PMID: 27566797] doi:10.1136/annrheumdis-2016-209782 CrossrefMedlineGoogle Scholar3. June CH, Warshauer JT, Bluestone JA. Is autoimmunity the Achilles' heel of cancer immunotherapy? Nat Med. 2017;23:540-547. 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Use of immune checkpoint inhibitors in the treatment of patients with cancer and preexisting autoimmune disease. A systematic review. Ann Intern Med. 2018;168:121-30. doi:10.7326/M17-2073 LinkGoogle Scholar8. Johnson DB, Sullivan RJ, Ott PA, Carlino MS, Khushalani NI, Ye F, et al. Ipilimumab therapy in patients with advanced melanoma and preexisting autoimmune disorders. JAMA Oncol. 2016;2:234-40. [PMID: 26633184] doi:10.1001/jamaoncol.2015.4368 CrossrefMedlineGoogle Scholar9. Menzies AM, Johnson DB, Ramanujam S, Atkinson VG, Wong ANM, Park JJ, et al. Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab. Ann Oncol. 2017;28:368-376. [PMID: 27687304] doi:10.1093/annonc/mdw443 CrossrefMedlineGoogle Scholar10. Uldrick TS, Goncalves PH, Fling SP, Aleman A, Emu B. Interim safety analysis of Cancer Immunotherapy Trials Network-12 (CITN-22): a phase 1 study of pembrolizumab in patients with HIV and relapsed, refractory or disseminated malignancies. J Immunother Cancer. 2017;5 Suppl 2 87. Google Scholar Author, Article, and Disclosure InformationAffiliations: Cleveland Clinic Foundation, Cleveland, Ohio (L.H.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3079.Corresponding Author: Leonard H. Calabrese, DO, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail, [email protected]org.This article was published at Annals.org on 2 January 2018. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Leonard H. Calabrese, DO In this video, Leonard H. Calabrese, DO, offers additional insight into the article, "Sorting Out the Complexities of Autoimmunity and Checkpoint Inhibitors: Not So Easy." FiguresReferencesRelatedDetailsSee AlsoUse of Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Autoimmune Disease Noha Abdel-Wahab , Mohsin Shah , Maria A. Lopez-Olivo , and Maria E. Suarez-Almazor Metrics Cited bySafety and Efficacy of Checkpoint Inhibition in Patients With Melanoma and Preexisting Autoimmune Disease A Cohort StudyMonique K. van der Kooij, MD, Karijn P.M. Suijkerbuijk, MD, PhD, Maureen J.B. Aarts, MD, PhD, Franchette W.P.J. van den Berkmortel, MD, PhD, Christian U. Blank, MD, PhD, Marye J. Boers-Sonderen, MD, PhD, Jesper van Breeschoten, MSc, Alfonsus J.M. van den Eertwegh, MD, PhD, Jan Willem B. de Groot, MD, PhD, John B.A.G. Haanen, MD, PhD, Geke A.P. Hospers, MD, PhD, Djura Piersma, MD, PhD, Rozemarijn S. van Rijn, MD, PhD, Albert J. ten Tije, MD, PhD, Astrid A.M. van der Veldt, MD, PhD, Gerard Vreugdenhil, MD, PhD, Michiel C.T. van Zeijl, MD, Michel W.J.M Wouters, MD, PhD, Olaf M. Dekkers, MD, PhD, and Ellen Kapiteijn, MD, PhDFirst case of hemophagocytic lymphohistiocytosis secondary to cabozantinib with checkpoint inhibitorsImmunopathogenesis of Immune-Related Adverse Events from Cancer ImmunotherapyCheckpoint inhibitors: Interface of cancer and autoimmunity: Opportunity for second level precision medicineRisk of Cancer in 767 Patients with Giant Cell Arteritis in Western Norway: A Retrospective Cohort with Matched ControlsThe immunopathogenesis of rheumatic immune adverse events from checkpoint inhibitors: prospects for targeted therapyRheumatic immune-related adverse events from cancer immunotherapyCheckpoint inhibitors: complexities of immune-related AEs 16 January 2018Volume 168, Issue 2Page: 149-150KeywordsAutoimmune diseasesCancer immunotherapyClinical trial reportingClinical trialsDisclosureImmune responseImmunosuppressivesInflammatory bowel diseaseSystematic reviewsToxicity ePublished: 2 January 2018 Issue Published: 16 January 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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