PMID- 35912183
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220802
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 12
DP  - 2022
TI  - Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and 
      Preexisting Psoriasis: A Systematic Review and Meta-Analysis of Observational 
      Studies.
PG  - 934093
LID - 10.3389/fonc.2022.934093 [doi]
LID - 934093
AB  - BACKGROUND: Immunotherapies represented by immune checkpoint inhibitors (ICIs) 
      have revolutionized cancer treatment. A large part of the population has both 
      cancer and psoriasis but is usually excluded from ICI clinical trials because of 
      the dysregulated activation of the immune system. This is the first study to 
      evaluate the safety and efficacy of ICI therapy in patients with cancer and 
      preexisting psoriasis. METHODS: PubMed, EMBASE, Cochrane, and MEDLINE databases 
      were searched from inception through February 2022. Observational studies on 
      patients with cancer and confirmed psoriasis before ICI initiation were included. 
      Outcomes included the incidence of psoriasis flares, de novo immune-related 
      adverse events (irAEs), discontinuation rate due to flare/de novo irAEs, and 
      efficacy of ICI therapy. Clinical manifestations, management, and outcomes for 
      adverse events (AEs) were systematically reviewed. All pooled analyses were based 
      on a random-effects model using Stata software. Meta-regression and subgroup 
      analyses were performed to identify sources of heterogeneity. RESULTS: Twelve 
      studies involving 191 patients were included. The pooled incidence of psoriasis 
      flares was 45.0% (95% CI: 31.1%-58.9%, I(2) = 71.7%) and 44.9% (95% CI: 
      29.0%-60.7%, I(2) = 71.8%) for de novo irAEs. The tumor type, psoriasis subtype, 
      ICI class, and country were the main sources of heterogeneity. Grade 3-4 flares 
      occurred in 10.8% (95% CI: 5.3%-16.3%) of patients, and about 16.6% (95% CI: 
      10.7%-22.5%) of patients experienced grade 3-4 de novo irAEs. The estimated 
      incidence of ICI discontinuation due to AE was 18.5% (95% CI: 6.1%-30.8%, I(2) = 
      68.7%). The median times to develop flare and de novo irAEs were 44 and 63 days, 
      respectively. Endocrinopathies and colitis were the most common de novo irAEs. 
      Conventional therapy is effective for most AEs. The estimated objective response 
      rate (ORR) of ICIs was 38.1% (95% CI: 11.8%-64.3%, I(2) = 81.7%), and the disease 
      control rate (DCR) was 64.5% (95% CI: 55.3%-73.8%, I(2) = 0). CONCLUSIONS: The 
      flare of patients with cancer and preexisting psoriasis treated with ICI therapy 
      is frequent, but the incidence of de novo irAEs and the efficacy of ICI therapy 
      are comparable to those of the general population. Most AEs are mild and 
      manageable with conventional therapy, which required discontinuation of ICI 
      therapy in 18.5%. SYSTEMATIC REVIEW REGISTRATION: 
      https://www.crd.york.ac.uk/prospero/, identifier CRD42022320646.
CI  - Copyright (c) 2022 Yu, Zhou, Zhang, Tan, Zheng, Li and Cui.
FAU - Yu, Yixuan
AU  - Yu Y
AD  - Graduate School, Beijing University of Chinese Medicine, Beijing, China.
AD  - Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, 
      Beijing, China.
FAU - Zhou, Yang
AU  - Zhou Y
AD  - Graduate School, Beijing University of Chinese Medicine, Beijing, China.
FAU - Zhang, Xu
AU  - Zhang X
AD  - Graduate School, Beijing University of Chinese Medicine, Beijing, China.
AD  - Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, 
      Beijing, China.
FAU - Tan, Kexin
AU  - Tan K
AD  - Graduate School, Beijing University of Chinese Medicine, Beijing, China.
AD  - Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, 
      Beijing, China.
FAU - Zheng, Jiabin
AU  - Zheng J
AD  - Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, 
      Beijing, China.
FAU - Li, Jia
AU  - Li J
AD  - Graduate School, Beijing University of Chinese Medicine, Beijing, China.
AD  - Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, 
      Beijing, China.
FAU - Cui, Huijuan
AU  - Cui H
AD  - Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, 
      Beijing, China.
LA  - eng
PT  - Systematic Review
DEP - 20220715
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC9334704
OTO - NOTNLM
OT  - autoimmune disease (AID)
OT  - cytotoxic T lymphocyte-associated protein 4 (CTLA-4)
OT  - immune checkpoint inhibitor (ICI)
OT  - immune-related adverse event (irAE)
OT  - programmed cell death 1 (PD-1)
OT  - programmed cell death ligand 1 (PD-L1)
OT  - psoriasis
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/08/02 06:00
MHDA- 2022/08/02 06:01
PMCR- 2022/01/01
CRDT- 2022/08/01 03:58
PHST- 2022/05/02 00:00 [received]
PHST- 2022/06/20 00:00 [accepted]
PHST- 2022/08/01 03:58 [entrez]
PHST- 2022/08/02 06:00 [pubmed]
PHST- 2022/08/02 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2022.934093 [doi]
PST - epublish
SO  - Front Oncol. 2022 Jul 15;12:934093. doi: 10.3389/fonc.2022.934093. eCollection 
      2022.