Atezolizumab, autoimmunity and Ig
Question:
7/10/2019
I have a 68 year-old gentleman with CVID receiving subcutaneous Ig infusions who developed recurrent lung cancer, now stage IV. Hematology wants to start Atezolizumab and is concerned regarding him being on subcutaneous Ig infusions and have asked to us halt his therapy for two months fearing a potential increased risk of autoimmune reactions that are known to occur with Atezolizumab. The drug company has no information on the combination of these two medications. I am fearful of stopping his infusion therapy as he has had multiple recurrent pneumonias and feel he needs protection during this new treatment as it can cause neutropenia, lymphopenia, and septic shock, autoimmune diseases among a multitude of other side effects. Do you or anyone on this panel have experience using these two medications together? Is there a concern regarding an increased risk of autoimmune disease? Do you feel his immunoglobulin infusions should be stopped during Atezolizumab therapy?
Answer:
I asked Dr. Charlotte Cunningham-Rundles, MD, PhD, for her input regarding your question. Her response is as follows:
"No experience [with Atezolizumab and Ig together]. But 2 things: if he has a very low IgG and no history of autoimmunity, the medication is less likely to lead to autoimmunity than in normal patients. Second, Ig in general tends to help in autoimmunity in CVID; not the reverse."
I hope this information is helpful.
Regards,
Daniel J. Jackson, MD, FAAAAI