POS1412 FIRSTS RESULTS OF THE PRAISE STUDY (PATIENT-REPORTED AUTOIMMUNITY SECONDARY TO CANCER IMMUNOTHERAPY): MULTICENTRIC PROSPECTIVE COHORT STUDY ON AUTOIMMUNE DISEASES SECONDARY TO CANCER IMMUNOTHÉRAPY

Background

In cancer immunotherapy, T-lymphocyte activation can lead to secondary autoimmune diseases named OASI for Opportunistic Autoimmunity Secondary to cancer Immunotherapy [1]. The epidemiology of OASI deserves to be further studied due to the unadapted reporting of clinical trials and the lack of prospective studies. Moreover, literature focuses on the most severe OASI and/or on specific OASI (myocarditis, colitis, arthritis).

Objectives

Our goal was to determine incidence, severity of all grade OASI using a multicentric prospective patient cohort starting treatment with cancer immunotherapy.

Methods

We present a multicentric, prospective, observational, longitudinal, real life, French e-cohort. 900 patients treated with ipilimumumab and/or nivolumab will be included. Data is collected from the patient and the oncologist at inclusion, then patients report directly any symptom that could be suggestive of OASI with the help of monthly digital questionaries. In case an OASI is suspected, further confirmation is made with the practician in charge and by a paired analysis with the Système National De Santé (SNDS), the French health insurance registry.

Results

On the 19/01/2022, 439 patients were included, 310 males (70.6%) and 129 females (29.4%). Mean age is 66 years old with a median follow up of 192 days. 354 patients (80.6%) are treated with Nivolumab alone, 7 (1.6%) with Ipilimumab alone and 76 (17.8 %) with combined Nivolumab + Ipilimumab. 136 patients (31.6%) are treated for a non-small cell lung carcinoma, 107 patients (24.9%) for a clear cell renal carcinoma, 91 patients (21.2%) for a skin melanoma, 49 patients (11.4%) for a head or neck epidermoid carcinoma, 24 patients (5.6%) for another lung cancer sub-type, and 32 patients (5.3%) for another histological cancer type. The mean follow-up is 294 days (+/- 192). 83 patients (18.9%) died since the beginning of the follow up.

47 patients (10.7%) developed 63 OASI. The mean delay between the beginning of cancer immunotherapy and the OASI is 134.7 days (+/- 103.4).

Approximately, one third of the OASI were musculoskeletal diseases. The OASI included polymyalgia rheumatica (3 patients), psoriatic arthritis (1 patient), polyarthritis (1 patient) systemic lupus (1 patient), arthralgias and myalgias (8 patients), colitis (11 patients), dysthyroïditis (6 patients), hepatitis (4 patients), nephritis (3 patients), pneumonitis (2 patients), hypophysitis (2 patients), adrenal insufficiency (4 patients), myocarditis (1 patient), hemophagocytic lympho-histiocytosis (1 patient), and other types of OASI (15 patients).

26 patients (55% of patients with OASI, 5,9% of all patients) had to stop cancer immunotherapy due to an OASI, one because of a rheumatic disease (systemic lupus). 52 patients were treated with corticosteroids, 1 patient with methotrexate (psoriatic arthritis), 3 patients with infliximab (colitis) and 1 patient with abatacept (myocarditis). 1 patient died after an OASI (colitis).

Conclusion

The first results of this prospective study, using an original patient-centered methodology, confirm the expected incidence of autoimmune events secondary to cancer immunotherapy and the role of rheumatologists in their therapeutic management.

References

[1]Kostine M, Chiche L, Lazaro E, et al. Opportunistic autoimmunity secondary to cancer immunotherapy (OASI): An emerging challenge. Rev Med Interne. 2017;38(8):513-525. doi:10.1016/j.revmed.2017.01.004

Acknowledgements

BMS funded the study (unrestricted grant) but had no role in study design, data collection, analysis or decision to publish.

Disclosure of Interests

Eden Sebbag: None declared, Nicolas Cloarec: None declared, Philippe Barthelemy: None declared, Nathanaël Sedmak: None declared, Naima Hamamouche Consultant of: Work for Sanoia Digital CRO, Hervé Servy Consultant of: Work for Sanoia Digital CRO, Guillaume Desjeux Consultant of: Work for Sanoia Digital CRO, Isabelle Monnet: None declared, Abeer Najem: None declared, Marc Porneuf: None declared, Laetitia-Shanna Rajpar: None declared, Jérôme Meunier: None declared, Tévy San: None declared, Laure Chauvenet: None declared, Ariane DARUT JOUVE: None declared, Sabrina FALKOWSKI: None declared, Claudia Rizzo: None declared, Noémie Litrowski: None declared, Anthony Canellas: None declared, Jean-François Paitel: None declared, Marc Pracht: None declared, Jacques Cadranel: None declared, Laurence Weiss: None declared, Christos Chouaid: None declared, Thomas Aparicio: None declared, Stephane Nancey: None declared, Cécile Arnold: None declared, Erik Sauleau: None declared, Jaqcues-Eric Gottenberg: None declared

Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas (Observatoire dédié au Cancer Bretagne / Pays de la Loire)

BACKGROUND

In 2006, bevacizumab, a targeted therapy agent was combined with FOLFIRI for the firstline treatment of patients with unresectable metastatic colorectal cancer.

METHODS/RESULTS

A study on a homogenous series of 111 patients from the Brittany and Pays de la Loire areas who received bevacizumab-FOLFIRI as first-line treatment in 2006 showed the following results: 51 responses, 29 stabilisations, 21 progressions and 10 cases of toxicity prior to assessment. Median overall survival (OS) was 25.1 months and median progression-free survival was 10.2 months. Surgery secondary to treatment tripled median OS which reached 59.2 months in resected patients versus 18.8 months in unresected patients. Comparison of patients aged more or less than 70 years showed no differences in terms of benefits or risks.

CONCLUSION

Bevacizumab-FOLFIRI could be administered as part of a routine care protocol to elderly patients previously evaluated by a geriatric assessment and validated by a multidisciplinary staff.

What is the benefit for patients suffering from metastatic colorectal cancer (mCRC) after bevacizumab-based regimen (BBR), cetuximab-based regimen (CBR), and panitumumab (P)?

595

Background: Metastatic colorectal cancer (mCRC) management has been clearly improved by targeted therapies such as anti VEGF and /or anti-HER1 drugs. The evaluation of the use of targeted therapies in the real world is strategic to assess health politics. OMIT Bretagne-Pays de la Loire is a network of private and public cancer centers that has been leading cohort studies evaluating Folfiri-bevacizumab treatment, the cost of targeted therapies and the succession of targeted therapies.

Methods: The purpose of this study is to evaluate the benefit and safety of three consecutive targeted therapies in patients with KRAS wild-type unresectable mCRC. Sex, age, localization of the primary tumor site, successive chemotherapeutic regimens, toxicities, response rates, progression free survival and overall survival have been studied.

Results: 34 patients (22 men, 12 women, median age 63 years [43-82]) have been prospectively recruited between 2003 and 2010. All of them received bevacizumab specially in association with FOLFIRI, cetuximab in association with irinotecan, panitumumab as monotherapy and others chemotherapies than FOLFOX, FOLFIRI, XELOX. The primary tumor site was colon (71%), junction (5%), and rectum (24%). 22 patients had metastatic colorectal tumor, 28 were operated on their primary tumor and 12 underwent resection after one line of treatment. Patients received successively 3 to 8 different lines of treatment for progressive mCRC. Toxicities of targeted therapies were manageable. Objective responses were observed in 38% (13) of the patients treated with BBR, 37% (11) treated with CBR and 25% (6) treated with P. Disease stabilization was achieved in 32% (11) of the patients treated with BBR, in 10% (3) with CBR and in 8% (2) with P. PFS at 80 months is 15%. Median OS from first metastatic line at death was 47.43 months (24.23-70.84). PFS and OS curves will be shown during the meeting.

Conclusions: Our study clearly shows that patients receiving successively the three schedules (BBR, CBR, P) have a high overall survival with manageable side effects.

No significant financial relationships to disclose.

Long Term Persistent Alopecia and Suboptimal Hair Regrowth after Adjuvant Chemotherapy for Breast Cancer: Alert for an Emerging Side Effect: ALOPERS Observatory

Background: Since 2003, through the impetus given by Pr Erick Gamelin and the Regional Health Agency in Western France (Bretagne, Pays de Loire), a network called OMIT (Drugs and Emerging Therapeutics Observatory) has been created, including the Breast Cancer Forum. Anthracyclins and taxanes are the cornerstones of adjuvant chemotherapy for breast cancer. In France, since the PACS 01 publication1, FEC 100 followed by docetaxel 100 has been the standard adjuvant chemotherapy regimen in breast cancer. Long term toxicities like persistent alopecia or suboptimal hair regrowth have been observed.Methods: Over the last year, the first cases of persistent alopecia or suboptimal hair regrowth after adjuvant chemotherapy have been reported to the Breast Cancer Forum. Consequently, OMIT quickly drew up a case report form and mailed it to every oncologist in Western France to collect data.Results: From May 2008 to April 2009, 66 cases of persistent alopecia or suboptimal hair regrowth after adjuvant chemotherapy from 15 different institutions were declared to OMIT: median age: 60 years (35-78), hypothyroidia: 11, fine hair before treatment: 2. Alopecia was localized: 13, diffuse: 49, complete: 4. The time lapse between the end of chemotherapy and persisting alopecia has been more than 3 months: 5 patients, more than 6 months: 10, more than 12 months: 22, more than 24 months: 29. The chemotherapy regimens were various: schedule FEC (epirubicin 100 mg/msq), 3 courses followed by docetaxel 100 mg/msq, 3 courses: 54, docetaxel 100 mg/msq: 3, TCH (docetaxel-carboplatin-trastuzumab) or TH: 2, FEC 100: 2, epirubicin 75 mg/msq in association with docetaxel 75 mg/msq: 2. Hormonotherapy: letrozole: 13, anastrozole: 18, exemestane: 3, tamoxifene: 14, LH-RH agonist: 3. No hormonotherapy: 13. In some institutions, according to the ECOG trial2, some oncologists quickly decided to change their standard regimen from FEC 100 - docetaxel 100, to EC 100 4 courses followed by weekly paclitaxel for 12 weeks: forthcoming data on persistent alopecia, suboptimal hair regrowth or neuropathy after this ECOG adjuvant chemotherapy regimen will be presented at the symposium.Conclusion: For the first time in France, Western OMIT offers us data about persistent alopecia or suboptimal hair regrowth after adjuvant chemotherapy: it is an important side effect and must be considered by oncologists as optimal information to give to curable patients. The next step is to evaluate the real incidence of this phenomen on the population of patients treated by adjuvant chemotherapy for breast cancer: OMIT is currently working with the Federation Nationale des Centres de Lutte contre le Cancer (FNCLCC) to collect data from prospective trials such as PACS 01 (FEC versus FEC-docetaxel), PACS 04 (FEC versus epirubicin-docetaxel) and PACS 05 (FEC 6 courses versus 4 courses), to create the ALOPACS database.1- Roché H. Sequential Adjuvant Epirubicin-based Regimen and Docetaxel Chemotherapy for node-positive Breast Cancer Patients: the FNCLCC PACS 01 Trial. J Clin Oncol. 2006 dec 20; 24 (36) 5664-71.2- Sparano JA.Weekly Paclitaxel in the Adjuvant Treatment in Breast Cancer. N Engl J Med. 2008 Apr 17; 358(16): 1663-71.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3174.

Unusual erythema elevatum diutinum with fibrohistiocytic proliferation

A 78-year-old woman with a history of symmetrical erythematous plaques on the arms, and a monoclonal gammopathy, developed a strange striped reticulate papular dermatosis with central atrophy. Histological examination was compatible with a very late stage of erythema elevatum diutinum (EED), showing a fibrohistiocytic proliferation with areas of granulation tissue. This fibrosis may result from the chronic dermal injury of leucocytoclastic vasculitis and is sometimes the predominant histology of EED. Investigations for underlying haematological anomalies, such as paraproteinaemia and infection with human immunodeficiency virus, must be performed. Dapsone is ineffective once the fibrous nodules have appeared.

Hydroxyurea-induced dermatomyositis-like eruption

Hydroxyurea is frequently used to treat myeloproliferative syndromes. Cutaneous lesions resembling those seen in dermatomyositis have rarely been reported in the course of treatment with hydroxyurea. We report six additional patients with this unusual adverse effect. All of the patients had a very typical and similar cutaneous eruption, with scaly, linear erythema on the dorsa of the hands. Leg ulceration occurred in two cases. Muscle involvement was never observed. One patient had unexplained lung disease. In all the others the disorder pursued a benign course, even when hydroxyurea was not withdrawn. Dermatomyositis-like lesions seem to be a not infrequent and characteristic adverse reaction to hydroxyurea. Investigations are not required, and the course is usually benign.

Antiphospholipid antibody production during Mediterranean spotted fever

Antiphospholipid antibodies (aPLA) were discovered during the course of Mediterranean spotted fever (MSF) caused by Rickettsia conorii and characterized by endothelial cell (EC) damage resulting from this organism's tropism for EC. In two MSF patients, two types of aPLA were identified: antiphosphatidylethanolamine antibodies detected by immunological methods and lupus anticoagulant detected by clotting assays. The persistence of both aPLA for several months after the acute phase and clinical recovery might correspond to a durable immunological response to membrane damage of EC caused by R. conorii. Their possible role in the pathophysiology of microthrombi formation observed during MSF remains to be elucidated in a study on a larger number of patients.

[Syndrome of hemophagocytosis associated with infections]

Infection-related hemophagocytic syndrome was originally described in viral processes by Risdall in 1979. Recent reports have suggested associations of this syndrome with bacterial, parasitic and fungal infections. It occurs generally in immunosuppressed patients. The clinical and biological manifestations are not specific. The diagnosis is based on morphologic examination of the bone marrow showing a benign proliferation of histiocytes with hemophagocytosis. Treatment is symptomatic, however when an infectious etiology is found a specific treatment must be applied. This pathology has a poor prognosis, with a fifty percent mortality rate. When evolution is favorable, relapses are exceptional. The precise pathophysiological mechanism has not yet been determined. A better understanding of the cytokines' role should permit to consider new therapeutic routes.

[Paraneoplastic edema syndromes in acute myelomonocytic leukemia: role of TNF-alpha and IL-6?]

We report the case of a 56 year-old man in remission of a Hodgkin's disease who had an acute myelomonocytic leukemia with major edemas. Chemotherapy temporarily allowed a concomitant regression of edemas, hyperleukocytosis and tumor necrosis factor and interleukin-6 levels which were initially elevated. We discuss the role of these two cytokines in endothelium permeability disorders.

C3d,g deposits in inflammatory skin diseases: use of psoriatic skin as a model of cutaneous inflammation

Recent studies in our laboratories have shown that human keratinocytes synthesize and secrete complement components including C3. Moreover, human keratinocyte-derived C3 is regarded as a potential source of C3d,g, a recently described constituent of the sublamina densa region of normal epidermal basement membrane. Additionally, human keratinocyte-derived C3 may also contribute to epidermal basement membrane deposits of C3 in autoimmune or inflammatory skin disorders. To further our understanding of the specificity and origin of epidermal basement membrane C3 deposits in normal and diseased skin, we have characterized in situ deposits of C3 and C3 cleavage fragments in various inflammatory skin diseases and utilized a skin equivalent model to assess the deposition of C3 cleavage fragments in neo-basement membrane of epidermal outgrowths from normal or diseased human skin. C3d,g reactivity was found to be greater in all samples of inflamed skin, and typically associated with C3c reactivity at these sites. No immunoglobulins or other complement components were detected. When lesional psoriatic skin rich in epidermal basement membrane C3c was used in our organ culture system, C3 incorporation within neo-basement membrane was observed. These results show that human keratinocyte-derived C3 may contribute to inflammatory reactions in skin as well as account for deposits of C3d,g in normal epidermal basement membrane.