Immune-checkpoint inhibitors to treat cancers in specific immunocompromised populations: a critical review

Expert Rev Anticancer Ther. 2018 Oct;18(10):981-989. doi: 10.1080/14737140.2018.1499468. Epub 2018 Jul 20.

Abstract

Because of their efficacy against numerous cancers, immune-checkpoint inhibitors (ICIs), anti-cytotoxic T-lymphocyte antigen-4, and anti-programmed cell death monoclonal antibodies are being used ever more often in oncology. However, some patients were excluded from clinical trials because of their comorbidities despite their potentially higher cancer frequencies, as is the case for immunocompromised patients. Areas covered: We analyzed reported preclinical and clinical information and evaluated the risk/benefit ratio for four immunocompromised populations: people living with human immunodeficiency virus (PLHs), solid-organ transplant recipients, recipients of hematopoietic stem-cell allografts, and patients with autoimmune diseases. Expert commentary: Information available in the literature is fragmentary and scarce, making it difficult to evaluate the risk/benefit ratio. It can, nonetheless, be noted that ICI use in PLHs seems possible. For solid-organ transplant recipients, the risk for the graft seems elevated. For the other two populations, it is difficult to conclude at this time.

Keywords: Autoimmune diseases; cancer; hematopoietic stem-cell allograft; human immunodeficiency virus; immune checkpoints inhibitors; transplant.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / immunology
  • Antineoplastic Agents, Immunological / therapeutic use*
  • CTLA-4 Antigen / immunology
  • Clinical Trials as Topic / methods
  • Humans
  • Immunocompromised Host / immunology*
  • Neoplasms / drug therapy*
  • Neoplasms / immunology
  • Neoplasms / pathology
  • Transplant Recipients

Substances

  • Antibodies, Monoclonal
  • Antineoplastic Agents, Immunological
  • CTLA-4 Antigen
  • CTLA4 protein, human