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01-05-2018 | Original Article

Ipilimumab in metastatic melanoma patients with pre-existing autoimmune disorders

Authors: Katharina C. Kähler, Thomas K. Eigentler, Anja Gesierich, Lucie Heinzerling, Carmen Loquai, Friedegund Meier, Frank Meiss, Claudia Pföhler, Max Schlaak, Patrick Terheyden, Kai M. Thoms, Mirjana Ziemer, Lisa Zimmer, Ralf Gutzmer, For the German Dermatologic Cooperative Oncology Group (DeCOG)

Published in: Cancer Immunology, Immunotherapy | Issue 5/2018

Abstract

Background

Ipilimumab and programmed death (PD) 1-antibodies are effective treatment options in metastatic melanoma. The safety and efficacy of ipilimumab in patients with pre-existing autoimmune disorders (AD) has only been evaluated in a selected number of patients.

Methods

We performed a retrospective analysis in 14 German skin cancer centers for patients with metastatic melanoma and pre-existing AD treated with ipilimumab.

Results

41 patients with 44 pre-existing AD were treated with ipilimumab (thyroiditis n = 15, rheumatoid n = 11, dermatologic n = 10, Crohn’s disease/ulcerative colitis n = 3, neurological n = 2, sarcoidosis n = 2, pancreatitis n = 1). 3 out of 41 patients had two AD, 11 patients required immunosuppressants at the time of induction of ipilimumab. 12 patients (29.2%) experienced a flare of their pre-existing AD, mainly patients with rheumatoid or dermatologic diseases. Additional immune-related adverse events (irAEs) occurred in 12 patients (29.2%). In 23 patients (56%) neither a change of their AD nor additional irAEs were observed. Objective responses were seen in five patients (one complete remission, four partial remissions, 12.1%).

Conclusion

This is the largest series of patients with pre-existing AD and treatment with ipilimumab reported. Flares of pre-existing AD were observed but manageable. Response rates and occurrence of new irAEs were comparable to previous trials. Thus, in this patient subgroup, ipilimumab can be a treatment option after a thorough discussion of pros and cons and taking severity and activity of the preexisting AD into account.

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Title: Ipilimumab in metastatic melanoma patients with pre-existing autoimmune disorders
Authors: Katharina C. Kähler
Thomas K. Eigentler
Anja Gesierich
Lucie Heinzerling
Carmen Loquai
Friedegund Meier
Frank Meiss
Claudia Pföhler
Max Schlaak
Patrick Terheyden
Kai M. Thoms
Mirjana Ziemer
Lisa Zimmer
Ralf Gutzmer
For the German Dermatologic Cooperative Oncology Group (DeCOG)
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: Cancer Immunology, Immunotherapy / Issue 5/2018
Print ISSN: 0340-7004
Electronic ISSN: 1432-0851
DOI: https://doi.org/10.1007/s00262-018-2134-z

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