There is no increased relapse risk in patients with multiple sclerosis (MS) and comorbid cancer who are receiving immune checkpoint inhibitor (ICI) therapy, results of a small study suggest.
MS patients may be at higher risk for certain cancers, such as melanoma and lung cancer. Although ICIs have proven effective in these cancers, they have a number of side effects, including inflammatory toxicities that mimic autoimmune diseases.
“Overall, our data are reassuring,” study author Prashanth Rajarajan , MD, PhD, a resident in the Department of Neurology, Brigham and Women’s Hospital, told Medscape Medical News. “The high risk of cancer progression or cancer-associated mortality outweighs the low risk of MS relapse secondary to use of ICIs.”
The findings were presented on April 15 at the American Academy of Neurology 2024 Annual Meeting.
Inhibiting Checkpoints
ICIs are humanized monoclonal antibodies that target proteins on immune cells and are effective in a variety of cancers. However, they are associated with immune-related adverse events and can exacerbate preexisting autoimmune diseases.
Because most clinical trials of ICIs have excluded people with MS, the incidence of ICI-induced MS activity is unknown.
“So, doctors wonder if this is an appropriate choice of treatment,” said Rajarajan.
The retrospective study included 65 patients with MS and comorbid cancer treated with ICIs at eight tertiary medical centers. Of these, 55 had relapsing-remitting MS and 10 had progressive MS, either primary or secondary disease.
Participants were older (median age, 66 years), and almost three quarters were female (72%).
About one third of patients (32%) were receiving disease-modifying therapy immediately before ICI initiation, and all continued their MS treatment during ICI therapy.
Researchers collected data on MS and cancer history as well as treatments and outcomes. The most common primary tumors among study participants were melanoma and lung cancer.
Over a follow up of 11.3 months after ICI initiation, only one patient experienced clinical relapse with symptoms and corresponding lesions on MRI. Another patient had MRI lesions without symptoms.
“The study demonstrates that the rate of MS relapses or disease activity in older patients with MS who receive ICI treatment is quite low,” said Rajarajan.
Three patients had neurologic immune adverse events, including encephalitis, Guillain-Barré syndrome, and sensory neuronopathy, and 21 had a nonneurologic immune-related adverse event.
Twenty-five participants (38.5%) had either partial or complete remission of their cancer at last follow-up.
The study included mostly older patients who tend to have fewer relapses and disease activity overall. The results may not generalize to younger patients, who tend to have more active disease, Rajarajan said.
MS Should Not Prevent Cancer Treatment
“These results suggest the diagnosis of MS should not prevent neurologists and oncologists from getting these patients the treatment they need for cancer,” said Rajarajan.
The team plans to study the impact of ICI therapy in people with other neuroimmunologic conditions, such as neuromyelitis optica, a condition that causes inflammation in optic nerves and the spinal cord.
“Perhaps not all autoimmune conditions are equal in the risk of relapse or other immune adverse events,” said Rajarajan.
He emphasized the need for more research and noted that studies investigating the effects of ICIs should not exclude people with MS.
Commenting on the findings for Medscape Medical News, Justin Jordan, MD, clinical director of neuro-oncology at Massachusetts General Hospital and associate professor of neurology at Harvard Medical School, Boston, Massachusetts, said these preliminary data are encouraging, but the numbers are small and the data retrospective.
“The results invite early optimism, and suggest a need for broader study, with a particular focus on younger patients and those who are on disease-modifying therapies for MS,” Jordan said.
Jordan stressed the “critical” need for research in this area. As use of ICIs for many systemic cancers increases, “the co-occurrence of multiple sclerosis and ICI-treatable malignancies will continue to grow,” he said.
“There remains a lot that we don’t know about using tumor-directed immunotherapies for patients with autoimmune conditions,” he added.
There was no outside funding for this study, and no relevant conflicts of interest were disclosed.
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