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

The oncologist

article

Andrea Antonuzzo¹  Alessandro Peri²  Elena Margherita Presotto²  Maria Francesca Egidi³  Luca Giacomelli⁴  Ferruccio Farroni⁶  Massimo Di Maio⁷  Emmanuele De Luca⁷  Marco Danova⁹  Florian Scottè^1,10  Karin Jordan^1,11  Fabio Calabrò^1,12  Paolo Bossi^1,13  Pietro Quaglino^1,14  Fausto Roila^1,15  Gian Domenico Sebastiani^1,16  Francesco Spina^1,17  Giuseppe Pasqualetti^1,18  Diego Cortinovis^1,19  Enrico Tagliaferri^2,20 

[1] UO Oncologia 1 SSN Polo Oncologico;Sodium Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi Hospital;Azienda Ospedaliero Universitaria Pisana (AOUP);Department of Surgical Sciences and Integrated Diagnostics, University of Genoa;Polistudium SRL;Gastroenterology Department, Foligno Hospital, Unità Sanitaria Locale Umbria 2;Department of Oncology, University of Turin;Division of Medical Oncology, Azienda Ospedaliero Ordine Mauriziano Hospital;Department of Internal Medicine and Medical Oncology, Vigevano Civic Hospital;Medical Oncology and Supportive Care Department, Hôpital Foch;Universitätsklinikum Heidelberg;San Camillo and Forlanini Hospital;University of Brescia;Dermatologic Clinic, Department of Medical Sciences;Department of Medical Oncology, Azienda Ospedaliera, Universitaria Perugia;Unità Operativa Complessa di Reumatologia, Ospedale di Alta Specializzazione “San Camillo;Division of Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori;Geriatrics Unit, Department of Clinical and Experimental Medicine;SS Lung Unit;UO Malattie Infettive

关键词: Cancer;    Immune checkpoint inhibitors;    Infections;    Rheumatic diseases;    Autoimmune diseases;   

DOI  :  10.1634/theoncologist.2020-0035

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

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.

【 授权许可】

CC BY|CC BY-NC