Cancer immunotherapy with checkpoint inhibitors (CPIs) is associated with frequent immune-related adverse events (irAEs) and is often not recommended for patients with concomitant autoimmune disease.

To summarize the evidence on adverse events associated with CPIs in patients with cancer and preexisting autoimmune disease.

MEDLINE, EMBASE, Web of Science, PubMed ePubs, and the Cochrane Central Register of Controlled Trials through September 2017 with no language restrictions.

Original case reports, case series, and observational studies describing patients with cancer and autoimmune disease who were receiving CPIs.

2 reviewers independently extracted data and assessed the quality of reporting.

123 patients in 49 publications were identified; 92 (75%) had exacerbation of preexisting autoimmune disease, irAEs, or both. No differences in adverse events were observed in patients with active versus inactive disease. Patients receiving immunosuppressive therapy at initiation of CPI therapy seemed to have fewer adverse events than those not receiving treatment. Most flares and irAEs were managed with corticosteroids; 16% required other immunosuppressive therapies. Adverse events improved in more than half of patients without discontinuation of CPI therapy. Three patients died of adverse events.

The quality and quantity of data were limited. Case reports typically describe unique manifestations and are not generalizable to the population at large. Because there were no prospective observational studies, incidence could not be determined.

Flares and irAEs in patients with autoimmune disease who are receiving CPIs can often be managed without discontinuing therapy, although some events may be severe and fatal. Prospective longitudinal studies are needed to establish incidence of adverse events and evaluate risk–benefit ratios and patient preferences in this population.

National Institute of Arthritis and Musculoskeletal and Skin Diseases.

使用检查点抑制剂（CPIs）进行的癌症免疫治疗与频繁的免疫相关不良事件（irAEs）相关，并且通常不建议伴有自身免疫性疾病的患者使用。

总结与癌症和先前存在的自身免疫性疾病患者的CPI相关的不良事件的证据。

MEDLINE，EMBASE，Web of Science，PubMed ePubs和Cochrane对照试验中央注册截止到2017年9月，没有语言限制。

描述接受CPI的癌症和自身免疫性疾病患者的原始病例报告，病例系列和观察性研究。

2名审阅者独立提取数据并评估了报告的质量。

确定了49篇出版物中的123例患者；92名（75％）患有既往的自身免疫性疾病，irAE或两者加重。在活动性和非活动性疾病患者中未观察到不良事件的差异。与未接受治疗的患者相比，在CPI治疗开始时接受免疫抑制治疗的患者发生的不良事件更少。大多数耀斑和irAEs均使用皮质类固醇治疗；16％的患者需要其他免疫抑制疗法。在不中断CPI治疗的情况下，超过一半的患者不良事件得到改善。三例患者死于不良事件。

数据的质量和数量是有限的。病例报告通常描述独特的表现，并且不能推广到整个人群。因为没有前瞻性观察研究，所以无法确定发病率。

接受CPI的自身免疫性疾病患者的耀斑和irAEs通常可以在不中断治疗的情况下得到处理，尽管某些事件可能是严重的和致命的。需要进行前瞻性的纵向研究来确定不良事件的发生率并评估该人群的风险收益比和患者的喜好。

国立关节炎与肌肉骨骼和皮肤病研究所。