Worsening and newly diagnosed paraneoplastic syndromes following anti-PD-1 or anti-PD-L1 immunotherapies, a descriptive study - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Article Dans Une Revue Journal for Immunotherapy of Cancer Année : 2019

Worsening and newly diagnosed paraneoplastic syndromes following anti-PD-1 or anti-PD-L1 immunotherapies, a descriptive study

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 IGR - Institut Gustave Roussy
3 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
4 Service de rhumatologie
5 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
6 DITEP - Département d’Innovation Thérapeutique et essais précoces [Gustave Roussy]
7 UNICANCER/ICO - Institut de Cancérologie de l'Ouest [Angers/Nantes]
8 CETHIL - Centre d'Energétique et de Thermique de Lyon
9 Laboratoire de biochimie générale [Rouen]
10 CHRO - Centre Hospitalier Régional d'Orléans
11 CHU Estaing [Clermont-Ferrand]
12 UB - Université de Bordeaux
13 UBO - Université de Brest
14 CHU Pitié-Salpêtrière [AP-HP]
15 BREST - ICH - Service d'Oncologie Thoracique
16 CHU Amiens-Picardie
17 LGPM - Laboratoire de Génie des Procédés et Matériaux - EA 4038
18 Service de Neurologie
19 Hôpital de Bayonne
20 Service de médecine interne [CHU Caen]
21 Centre Hospitalier Robert Schuman
22 Service de Pneumologie [CHRU Nancy]
23 Hôpital d'instruction des Armées Percy
24 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
25 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
26 IUT Clermont-Ferrand - Institut Universitaire de Technologie - Clermont-Ferrand
27 INMG - Institut NeuroMyoGène
28 UCBL - Université Claude Bernard Lyon 1
29 IMVA - U1184 - Immunologie des Maladies Virales et Autoimmunes
30 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
Marie Kostine
Léa Dousset
Gilles Quéré
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Franck Grados
  • Fonction : Auteur
  • PersonId : 1151072
  • IdRef : 092785344

Résumé

BACKGROUND: Paraneoplastic syndromes (PNS) are autoimmune disorders specifically associated with cancer. There are few data on anti-PD-1 or anti-PD-L1 immunotherapy in patients with a PNS. Our objective was to describe the outcome for patients with a pre-existing or newly diagnosed PNS following the initiation of anti-PD-1 or anti-PD-L1 immunotherapy. METHODS: We included all adult patients (aged ≥18) treated with anti-PD-1 or anti-PD-L1 immunotherapy for a solid tumor, diagnosed with a PNS, and registered in French pharmacovigilance databases. Patients were allocated to cohorts 1 and 2 if the PNS had been diagnosed before vs. after the initiation of immunotherapy, respectively. FINDINGS: Of the 1304 adult patients screened between June 27th, 2014, and January 2nd, 2019, 32 (2.45%) had a PNS and were allocated to either cohort 1 (n = 16) or cohort 2 (n = 16). The median (range) age was 64 (45-88). The tumor types were non-small-cell lung cancer (n = 15, 47%), melanoma (n = 6, 19%), renal carcinoma (n = 3, 9%), and other malignancies (n = 8, 25%). Eleven (34%) patients presented with a neurologic PNS, nine (28%) had a rheumatologic PNS, eight (25%) had a connective tissue PNS, and four (13%) had other types of PNS. The highest severity grade for the PNS was 1-2 in 10 patients (31%) and ≥ 3 in 22 patients (69%). Four patients (13%) died as a result of the progression of a neurologic PNS (encephalitis in three cases, and Lambert-Eaton syndrome in one case). Following the initiation of immunotherapy, the PNS symptoms worsened in eight (50%) of the 16 patients in cohort 1. INTERPRETATION: Our results show that PNSs tend to be worsened or revealed by anti-PD-1 or anti-PD-L1 immunotherapy. Cases of paraneoplastic encephalitis are of notable concern, in view of their severity. When initiating immunotherapy, physicians should carefully monitor patients with a pre-existing PNS.

Domaines

Cancer

Dates et versions

hal-02530293 , version 1 (02-04-2020)

Identifiants

Citer

Guillaume Manson, Alexandre Thibault Jacques Maria, Florence Poizeau, François-Xavier Danlos, Marie Kostine, et al.. Worsening and newly diagnosed paraneoplastic syndromes following anti-PD-1 or anti-PD-L1 immunotherapies, a descriptive study. Journal for Immunotherapy of Cancer, 2019, 7 (1), ⟨10.1186/s40425-019-0821-8⟩. ⟨hal-02530293⟩
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