Immune checkpoint inhibitors in patients with pre-existing psoriasis

Conference

WPPAC 2021

In a recent study, treatment with immune checkpoint inhibitors (ICIs) was associated with frequent disease exacerbations in patients with pre-existing psoriasis, but flares were manageable with standard psoriasis treatment. Few patients required discontinuation of ICIs. In addition, this study revealed excellent tumour outcomes [1].

ICIs are approved to treat multiple cancers [2]. Although retrospective analyses have demonstrated acceptable safety and similar efficacy of ICIs in patients with autoimmune diseases, they are often excluded for initial trials on ICIs due to concern for immune-related adverse events (irAEs). Even though ICIs have shown acceptable safety in patients with an autoimmune disease, disease flares and irAEs may still occur. Outcomes of ICI treatment in patients with psoriasis are not well-described.

In this retrospective, multicentre, cohort study, patients with pre-existing psoriasis who received ICI treatment for cancer were evaluated [1]. The 76 patients studied (66% men; median age 67 years) received the following ICI drugs: 67% received anti-PD-1/anti-PD-L1 antibodies, 11% anti-CTLA-4 antibodies, and 22% combination anti-PD-1/anti-CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (61%) and in some cases comorbid psoriatic arthritis (PsA; 20%). Over half of patients (54%) had received prior therapy for psoriasis, and only 2 patients (3%) were on active immunosuppression at initiation of the ICIs. With ICI treatment, 43 patients (57%) experienced a psoriasis flare. The median time from the initiation of ICI treatment to psoriasis flare was 44 days. Of the patients experiencing a flare, 23 (53%) were managed with topical therapy only. Only 5 patients (7%) needed to discontinue the ICIs due to a psoriasis flare.

Progression-free survival (PFS) and overall survival (OS) were significantly longer in patients with a psoriasis flare versus those without a flare (median PFS 39 vs 5.5 months, P=0.034; median OS not reached vs 29.3 months, P=0.045, respectively).

In this study, ICI treatment was associated with flares of pre-existing psoriasis. Most flares were manageable with topical treatment and few patients required ICI discontinuation. In addition, the occurrence of psoriasis flares was associated with improved survival. These results reveal excellent tumour outcomes, as patients who experienced disease exacerbations performed at least as well as those who did not, given the association of flares with improved PFS.

Halle B. Immune checkpoint inhibitors in patients with pre-existing psoriasis associated with manageable disease exacerbations and excellent tumor outcomes. Abstract O2, 6^th World Psoriasis & Psoriatic Arthritis Conference, 30 June–3 July 2021.
Vaddepally RK, et al. Cancers (Basel). 2020;12:738.

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