# Leveraging immune checkpoint inhibitors in lung cancer patients with pre-existing autoimmune disease: clinical insights, optimal timing, and predictive biomarkers for optimal treatment outcomes

## TL;DR

This paper reviews how immune checkpoint inhibitors can be safely and effectively used in lung cancer patients who also have autoimmune diseases.

## Contribution

The paper provides clinical insights and identifies predictive biomarkers for managing immune checkpoint inhibitors in lung cancer patients with pre-existing autoimmune conditions.

## Key findings

- Clinical evidence suggests ICIs can be safely used in lung cancer patients with autoimmune diseases.
- Optimal timing of ICI initiation and predictive biomarkers for immune-related adverse events are highlighted.
- Future studies are needed to develop definitive guidelines and new medications for this patient population.

## Abstract

The use of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, particularly in lung cancer. However, their use in patients with pre-existing autoimmune diseases (PADs) presents unique challenges. PADs, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and psoriasis, complicate the clinical management of lung cancer due to concerns about worsening autoimmune symptoms during ICI therapy. This review summarized the safety and efficacy of ICIs in lung cancer patients with PAD, focusing on the available clinical evidence, the optimal timing of ICI initiation, and the potential predictive biomarkers for immune-related adverse events (irAEs). Future prospective studies are needed to establish definitive guidelines for the use of ICIs in this population, with a focus on identifying patients at risk, managing ICI resumption after irAE and developing new medications with durable control of both cancer and PAD.