Response to PD-1 based immunotherapy in patients with preexisting autoimmune diseases receiving active immunosuppression

Abstract

In this study, we retrospectively examined 89 patients with stage IV malignant melanoma and pre-existing autoimmune disease with and without active immunosuppression regard- ing their response to PD-1 based immunotherapy. In this univariate analysis, the type of first-line therapy was significantly associated with longer overall survival (PD-1 monotherapy: mOS 79.5 months; p=0.010). Active immu- nosuppression was significantly associated with longer progression-free survival (PFS1 with immunosuppression: 4.1 months vs. 2.4 months without; p=0.028). Interestingly, established indicators of poor prognosis — elevated LDH and S100 serum levels and the presence of liver and brain metastases — did not show a significant impact on survival in PAD patients. Systemic treatment of metastatic melanomas with mono- or combined ICI therapy seems to be a viable and safe option for patients with PAD. Immune related adverse events did not generally occur more often or more severely than in patients without PAD. Current data suggest that immune checkpoint inhibitors can be used safely and effectively in patients with PAD, achieving response rates comparable to those reported in studies of patients without PAD. Further prospective studies should be conducted and clinical guidelines adapted accordingly.