Tocilizumab provides dual benefits in treating immune checkpoint inhibitor-associated arthritis and preventing relapse during ICI rechallenge: the TAPIR study.

arthritis immune checkpoint inhibitors irAEs secondary prophylaxis tocilizumab

Journal

Annals of oncology : official journal of the European Society for Medical Oncology
ISSN: 1569-8041
Titre abrégé: Ann Oncol
Pays: England
ID NLM: 9007735

Informations de publication

Date de publication:
04 Sep 2024
Historique:
received: 10 07 2024
revised: 04 08 2024
accepted: 19 08 2024
medline: 7 9 2024
pubmed: 7 9 2024
entrez: 6 9 2024
Statut: aheadofprint

Résumé

The aim of this retrospective study was to evaluate the dual efficacy of tocilizumab (TCZ) in the treatment of ICI-related arthritis (ICI-AR) and the prevention of relapses after rechallenge. We identified 26 patients with ICI-AR. The primary objectives were to evaluate TCZ efficacy in ICI-AR treatment and as secondary prophylaxis during ICI rechallenge in 11 of them. Patients received prednisone (CS) at 0.3 mg/kg tapered at 0.05 mg/kg weekly for six weeks. TCZ was administered at a dose of 8 mg/kg Q2w. In the subgroup receiving secondary prophylaxis (rechallenge n=11), TCZ was reintroduced with the same regimen concurrently with ICI rechallenge, and without the addition of CS. A control group of patients (rechallenge n=5) was rechallenged without TCZ. Secondary endpoints included post rechallenge evaluation of ICI duration, reintroduction of CS > 0.1 mg/kg/day, ICI-RA flares, and DCR. The median age of the patients was 70 years. The median follow-up from ICI initiation was 864 days. Among the 20 patients treated with TCZ for ICI-AR, all (100%) achieved an ACR70 response rate, defined as greater than 70% improvement, at 10 weeks. 81% of these patients achieved steroid-free remission after 24 weeks on TCZ. The median follow-up period was 552 days in rechallenged patients. The results demonstrated a reduction in ICI-AR relapses upon ICI rechallenge in patients receiving TCZ prophylaxis as compared to patients who did not receive prophylaxis (17% vs 40%). The requirement for CS was completely abolished with prophylaxis (0% vs 20%), and the mean duration of ICI treatment was notably extended from 113 to 206 days. The 12-month post-rechallenge outcomes showed a disease control rate (DCR) of 77%. During TCZ prophylaxis, CXCL9 remained elevated, showing no decline from their levels at the onset of ICI-AR CONCLUSIONS: In addition to treating ICI-AR, TCZ demonstrated efficacy as a secondary prophylactic agent, preventing the recurrence symptoms and lengthening ICI treatment duration after ICI rechallenge.

Sections du résumé

BACKGROUND BACKGROUND
The aim of this retrospective study was to evaluate the dual efficacy of tocilizumab (TCZ) in the treatment of ICI-related arthritis (ICI-AR) and the prevention of relapses after rechallenge.
PATIENTS AND METHODS METHODS
We identified 26 patients with ICI-AR. The primary objectives were to evaluate TCZ efficacy in ICI-AR treatment and as secondary prophylaxis during ICI rechallenge in 11 of them. Patients received prednisone (CS) at 0.3 mg/kg tapered at 0.05 mg/kg weekly for six weeks. TCZ was administered at a dose of 8 mg/kg Q2w. In the subgroup receiving secondary prophylaxis (rechallenge n=11), TCZ was reintroduced with the same regimen concurrently with ICI rechallenge, and without the addition of CS. A control group of patients (rechallenge n=5) was rechallenged without TCZ. Secondary endpoints included post rechallenge evaluation of ICI duration, reintroduction of CS > 0.1 mg/kg/day, ICI-RA flares, and DCR.
RESULTS RESULTS
The median age of the patients was 70 years. The median follow-up from ICI initiation was 864 days. Among the 20 patients treated with TCZ for ICI-AR, all (100%) achieved an ACR70 response rate, defined as greater than 70% improvement, at 10 weeks. 81% of these patients achieved steroid-free remission after 24 weeks on TCZ. The median follow-up period was 552 days in rechallenged patients. The results demonstrated a reduction in ICI-AR relapses upon ICI rechallenge in patients receiving TCZ prophylaxis as compared to patients who did not receive prophylaxis (17% vs 40%). The requirement for CS was completely abolished with prophylaxis (0% vs 20%), and the mean duration of ICI treatment was notably extended from 113 to 206 days. The 12-month post-rechallenge outcomes showed a disease control rate (DCR) of 77%. During TCZ prophylaxis, CXCL9 remained elevated, showing no decline from their levels at the onset of ICI-AR CONCLUSIONS: In addition to treating ICI-AR, TCZ demonstrated efficacy as a secondary prophylactic agent, preventing the recurrence symptoms and lengthening ICI treatment duration after ICI rechallenge.

Identifiants

DOI: 10.1016/j.annonc.2024.08.2340 PMID: 39241964
pubmed: 39241964
pii: S0923-7534(24)03920-6
doi: 10.1016/j.annonc.2024.08.2340
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

P-F Petit (PF)

Medical oncology service, CHU Helora, Rue Ferrer 159, 7100 La Louvière, Belgium.

D Daoudlarian (D)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

S Latifyan (S)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

H Bouchaab (H)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

N Mederos (N)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

J Doms (J)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

K Abdelhamid (K)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

N Ferahta (N)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

L Mencarelli (L)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

V Joo (V)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

R Bartolini (R)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

A Stravodimou (A)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

K Shabafrouz (K)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

G Pantaleo (G)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

S Peters (S)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Oncology, Medical Oncology Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

M Obeid (M)

Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Department of Medicine, Immunology and Allergy Service, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Electronic address: michel.obeid@chuv.ch.

Classifications MeSH