Autoimmune Diseases Induced By Biological Agents Used in Patients with Advanced Cancer: A nationwide multicenter registry of cases diagnosed in daily practice (cBIOGEAS-SEMI)

GUTIÉRREZ-GOSÁLVEZ INÉS; ROBLES-MARHUENDA ANGEL; CARMEN YLLERA GUTIÉRREZ ; CÉSAR MORCILLO ; RAMOS CASALS MANUEL; PEREZ ALVAREZ ROBERTO; PRIETO-GONZÁLEZ SERGIO; AGUILAR ROMO EVA MARÍA; FLORES-CHAVEZ ALEJANDRA; PEREZ DE LIS MARTA; RETAMOZO SOLEDAD; HERRANZ M. TERESA; BRITO ZERON PILAR; ANA CRISTINA ANTOLÍ-ROYO ; LUIS CAMINAL

Amsterdam

Congreso; EUROPEAN LEAGUE AGAINST RHEUMATISM (EULAR); 2018

EULAR

Aims. To characterize in a real-life-setting the development of autoimmune diseases triggered by the new biological therapies used as immunotherapy in patients with advanced cancer. Methods. In 2006, the Study Group on Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine created the BIOGEAS project, a multicenter study devoted to collecting data on the use and safety of biological agents in adult patients. In December 2016, the cBIOGEAS-SEMI multicenter registry was formed with the aim of collecting patients with cancer treated with biological immunotherapies who developed autoimmune diseases.Results. By January 2018, the cBIOGEAS-SEMI Registry includes 40 patients (26 men and 14 women, mean age of 59.7 yrs) who developed 54 triggered autoimmune diseases, including interstitial lung disease (n=11), enterocolitis (n=8), hypophysitis (n=6), polyarthritis (n=4), thyroiditis (n=3), vasculitis (n=3), severe cutaneous involvement (n=3), adrenalitis (n=2), Sjögren syndrome (n=2), cardiomyopathy (n=2), pancreatitis (n=2), Guillain-Barre syndrome (n=2), hepatitis (n=2) and CNS involvement, sclerosing cholangitis, glomerulonephritis and sarcoidosis (one case each). Underlying neoplasia consisted mainly in pulmonary neoplasia (n=16), melanoma (n=11) and breast cancer (n=3). Cancer immunotherapies included PD1 inhibitors (n=26), CTL4 inhibitors (n=7), growth factor/adhesion molecules inhibitors (n=4), combined PD1/CTL4 blockade (n=2) and TK inhibitors (n=1); biologics included nivolumab (n=20), ipilimumab (n=9), pembrolizumab (n=8), trastuzumab (n=3), catumaxomab (n=1) and vemurafenib/combimetinib (n=1). Glucocorticoids were used in all cases but 4 (9 patients received intravenous methylprednisolone pulses); 5 patients required additional therapies (intravenous immunoglobulins in 4, methotrexate in one). All cases responded to treatment with glucocorticoids except 4 patients who died (3 due to ILD and one due to neurological disease).Conclusion. A wide variety of systemic and organ-specific autoimmune diseases triggered by the new cancer immunotherapies is emerging. In this nationwide real-life Registry, immune checkpoint inhibitors are the biologics involved in nearly 90% of cases. We found an excellent response to glucocorticoids, with a poor prognosis in patients who developed pulmonary and neurological diseases.