Autoimmune Diseases May Limit Lung Cancer Patient Eligibility for Immunotherapy

In the wake of the expanded use of immunotherapy, a study published in JAMA Oncology found that some cancer patients also have an immune disease that may make them unsuitable for these treatments.

The study enrolled 210,509 lung cancer patients older than 65 years. Between 14% and 25% of lung cancer study participants had an immune disease, with female and older patients being more likely.

“Our team wanted to determine if this practice had a significant impact,” said first study author Saad Khan. “The new immunotherapy treatments also convey the risk of unpredictable, possibly severe, and potentially irreversible autoimmune toxicities affecting a variety of organs. With combination immunotherapy regimens, rates of these adverse events may exceed 50%.”

The researchers applied 2 different algorithms to measure the presence of an autoimmune disease. The most common autoimmune diseases recorded were rheumatoid arthritis, polymyalgia rheumatic, and psoriasis.

Khan noted that the relatively high rate of autoimmune diseases in lung cancer patients may be because of their older age at diagnosis and history of smoking.

“Since the use of cancer immunotherapy is growing, examining the effectiveness and toxicity of these promising treatments among patients with autoimmune diseases will be critical,” said researcher David Gerber. “While prior research has suggested that administering immune therapy to patients with autoimmune disease may be feasible, doing so carries the risk of making their disease worse, and requires careful monitoring.”

The findings cannot be generalized to other types of cancers because patients with lung cancer might be older and more frequently have smoking histories, according to the study. However, the study may provide researchers and physicians with a better understanding, and provide more effective treatment for cancer patients.

“Our findings provide the first robust estimate of autoimmune conditions among lung cancer patients,” said researcher Sandi Pruitt. “This study will influence clinical practice and the design of clinical trials, and raise additional research questions of critical importance to lung cancer patients and their doctors.”