AB0354 CAN CANCER TRIGGER AUTOIMMUNITY DISEASE? FEATURES OF AUTOIMMUNE DISORDER OF CANCER PATIENTS
Authors: Sayaka Tsuzuki, Hideyuki Takahashi, Fangyi Chen, Keigo Setoguchi
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Association between cancer and autoimmune diseases are reconsidered by frequent use of immune checkpoint inhibitor and its adverse effects. In addition, the childhood cancer patients have the higher possibility of developing autoimmune disease than general population in previous research, though this may be related to cancer therapy. Furthermore the development of scleraderma in cancer patients harboring the rPOLAR3A cancer mutation suggests that cancer may directly induce autoimmune disease. <h3>Objectives</h3> We examine the features of autoimmune diseases in the patient with pre-exisiting cancer. <h3>Methods</h3> Date on clinical characteristics, laboratory features, and treatment response from patients with autoimmune disease in our hospital were analyzed retrospectively. We excluded patients who had diagnosed cancer more than 5 years ago, who use immune check point inhibitor, whose symptom became clear by the drug toxicities and endocrine disease, and who had no symptoms but only test abnormalities. <h3>Results</h3> 149 patients consulted our department and 111 patients were included; their medina duration of follow-up was 39 months. The median period of diagnosing cancer from autoimmune disease was 17 months, and median age of the patients with autoimmune diseases at diagnosis was 68 years. Baseline manifestations included rheumatoid arthritis (RA) 42%, polymyalgia rheumatica (PMR) 20%, systemic scleroderma (SSc) 10%, Sjoegren syndrome (SjS) 7.3%, IgG4-related disease 6.3%, vasculitis 5.5%, polymyositis and dermatomyositis 5.5%, interstitial pneumonia 2.7%. In patients with RA, 53% were positive for both rheumatoid factor (RF) and anti-CCP antibody (median RF 155IU/mL, anti-CCP antibody 380U/mL). The median age of diagnosis was 68 years, and 52% were female. The average serum C-reactive protein (CRP) was 1.7mg/dL. Patients who experienced only operation for previous cancer therapy was 44%. 39% patients developed RA symptoms with in half year. As a treatment, MTX were used in 44%, SASP in 26%, PSL alone in 11%. The response to therapy was 70% overall. One patient who used MTX developed MTX-LPD (DLBCL) after 10 months. In PMR, all cases were seronegative. The median age of diagnosis was 71 years, and 63% were female. The average CRP was 5.4mg/dL. 41% of patients had operation for previous cancer therapy and 32% had operation and chemotherapy. All cases started using PSL (15-40mg) and responded to treatment. They all tapered PSL. In SSc, all cases were female and mean age was 63 year old. 33% of them had breast cancer. 82% had centromere antibody and the median titer of the antibody were 1280. Interestingly, even in SjS patients, the same antibody was positive in 38%. In myositis, 4 out of 6 patients had ARS antibodies and their main symptom was interstitial pneumonia. No patients were positive for TIF-1γ. Seeing from cancer side, 18% had colorectal cancer, 17% had breast cancer, 11% had lung cancer, 9% had gastric and uterine cancer. <h3>Conclusion</h3> Patients with cancer developed autoimmune diseases, and had different characteristics from primary autoimmune disease. This suggest that cancer itself and it's therapy somehow influence to our immune systems. <h3>Disclosure of Interests</h3> None declared