Immunotherapy in Underrepresented Populations of Patients with Cancer: Do We Have Enough Evidence at Present? A Focus on Patients with Major Viral Infections and Autoimmune Disorders
Open Access
- 1 June 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 25 (6), E946-E954
- https://doi.org/10.1634/theoncologist.2020-0035
Abstract
The safety and activity of immune checkpoint inhibitors have been characterized in interventional and observational studies. However, only small studies have specifically investigated these agents in patients who are excluded or underrepresented in clinical trials, frequently referred to as "special populations" or "underrepresented populations." These include older adults, those with dysregulated immune activation, patients with a compromised immune function, and those carrying major viral infections, lymphoproliferative diseases, and major organ dysfunctions. Therefore, there remains substantial uncertainty regarding the use of immune checkpoint inhibitors in these specific settings. The Network of Italian Supportive Care in Oncology has carried out a multidisciplinary project, with the contribution of oncologists and other specialists, to retrieve the existing evidence on the use of immunotherapy in patients with solid and hematological cancers with the final aim to provide an expert guidance. The results of this effort are presented in this article, which is focused on patients with major viral infections or those with immune dysregulation/autoimmune diseases, and could be useful to guide decisions in clinical practice and to design prospective clinical trials focusing on the use of immunotherapy in these populations. Implications for Practice Substantial uncertainty remains regarding the use of immune checkpoint inhibitors in "underrepresented" patients, such as older adults, those with dysregulated immune activation, and patients with a compromised immune function, major viral infections, lymphoproliferative diseases or major organ dysfunctions. The Network of Italian Supportive Care in Oncology has carried out a multidisciplinary project to retrieve the existing evidence on the use of immunotherapy in underrepresented patients with cancer in order provide an expert guidance. The results of this effort, with a focus on patients with major viral infections or those with immune dysregulation/autoimmune diseases, are presented in this article and could be useful to guide decisions both in clinical practice and to design clinical trials.This publication has 63 references indexed in Scilit:
- Hepatitis B virus reactivation in patients with solid tumors receiving systemic anticancer treatmentAnnals Of Oncology, 2016
- Tremelimumab in combination with ablation in patients with advanced hepatocellular carcinomaJournal of Hepatology, 2016
- Cancer immunotherapy in patients with preexisting autoimmune disordersSeminars in Immunopathology, 2016
- Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumabAnnals Of Oncology, 2016
- Selective inhibition of autoimmune exacerbation while preserving the anti-tumor clinical benefit using IL-6 blockade in a patient with advanced melanoma and Crohn’s disease: a case reportJournal of Hematology & Oncology, 2016
- Reactivation of hepatitis B virus during targeted therapies for cancer and immune-mediated disordersExpert Opinion on Biological Therapy, 2016
- Ipilimumab Therapy in Patients With Advanced Melanoma and Preexisting Autoimmune DisordersJAMA Oncology, 2016
- PD-1 Blockade in Advanced Melanoma in Patients with Hepatitis C and/or HIVCase Reports in Oncological Medicine, 2015
- PD-1 BlockersCell, 2015
- Case Report: Response to Ipilimumab in a Patient With HIV With Metastatic MelanomaJournal of Clinical Oncology, 2011