Durvalumab-associated vasculitis presenting as ‘the blue toe syndrome’

Gupta, Shivangi; Xu, Dan; Hadfield, Jane; Prentice, David

doi:10.1136/bcr-2020-235886

Cited by 11 publications

(3 citation statements)

References 21 publications

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“…Several irAEs of special interest have been described in elderly patients treated with PD1/PD-L1 axis inhibitors and are summarized in Table 2. They included severe cutaneous adverse reactions [135][136][137][138][139][140], secondary sclerosing cholangitis [141], colangiopathy [142,143], immune-related hepatitis [144,145], type 1 diabetes [146][147][148], hypophysitis [149], primary adrenal insufficiency [150], myasthenia gravis and myopathy [151][152][153][154], myocarditis [154][155][156][157], severe heart failure [158], eosinophilic vasculitis and arteritic anterior ischemic optic neuropathy [159], blue toe syndrome due to peripheral vasculitis [160], Vogt-Koyanagi-Harada Disease-like Uveitis [161], acute interstitial nephritis [134,162], fulminant Goodpasture's disease [163], neuromyelitis optica [164], isolated optic neuritis [165], encephalitis [166], hypereosinophilia [167], severe neutropenia [144,[168][169][170], immune thrombocytopenia [171], autoimmune hemolytic anemia and hemophagocytic lymphohist...…”

Section: Case Reportsmentioning

confidence: 99%

Immunotherapy in Elderly Patients Affected by Non-Small Cell Lung Cancer: A Narrative Review

Montrone

Rosati

Longo

et al. 2023

JCM

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Lung cancer is the leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all lung cancers, and most NSCLC is diagnosed in the advanced stage. The advent of immune check point inhibitors (ICIs) changed the therapeutic scenario both in metastatic disease (in first and subsequent lines) and earlier settings. Comorbidities, reduced organ function, cognitive deterioration, and social impairment give reasons for a greater probability of adverse events, making the treatment of elderly patients challenging. The reduced toxicity of ICIs compared to standard chemotherapy makes this approach attractive in this population. The effectiveness of ICIs varies according to age, and patients older than 75 years may benefit less than younger patients. This may be related to the so-called immunosenescence, a phenomenon that refers to the reduced activity of immunity with older age. Elders are often under-represented in clinical trials, even if they are a large part of the patients in a clinical practice. In this review, we aim to explore the biological aspects of immunosenescence and to report and analyze the most relevant and recent literature findings on the role of immunotherapy in elderly patients with NSCLC.

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Section: Case Reportsmentioning

confidence: 99%

Immunotherapy in Elderly Patients Affected by Non-Small Cell Lung Cancer: A Narrative Review

Montrone

Rosati

Longo

et al. 2023

JCM

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“…Durvalumab-associated acral vasculitis has previously been reported. 5 Cardiovascular irAEs other than AVEs include those that primarily affect the heart, such as myocarditis, cardiomyopathy, heart failure, and heart block. Though cardiovascular irAEs are overall rare, they can quickly cause severe morbidity and mortality, often due to arrhythmia or shock.…”

Section: Historymentioning

confidence: 99%

Rapidly progressing dyspnea and retiform purpura

et al. 2022

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“…Serologies rarely are positive, and the diagnosis is lack of autoantibodies in vasculitis. In a recently case with NSCLC, the patient developed acral vasculitis after receiving anti-PD-L1 mAb therapy ( 62 ). The laboratory test results revealed a positive perinuclear-ANCA, and negative anti-myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies.…”

Section: Autoimmune Iraesmentioning

confidence: 99%

Rheumatic Manifestations and Diseases From Immune Checkpoint Inhibitors in Cancer Immunotherapy

Shen

Chen

et al. 2021

Front. Med.

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Immune checkpoint inhibitors (ICIs), which can enhance antitumor immunity and inhibit cancer growth, have revolutionized the treatment of multiple cancers and dramatically decreased mortality. However, treatment with ICIs is directly associated with immune-related adverse events (irAEs) because of inflammation in off-target organs and autoimmunity resulting from non-specific immune activation. These irAEs can cause rheumatic diseases and manifestations such as inflammatory arthritis, polymyalgia rheumatica, myositis, vasculitis, Sicca and Sjogen's syndrome, and systemic lupus erythematosus. Early diagnosis and treatment of these adverse events will improve outcomes and quality of life for cancer patients. The treatment of rheumatic diseases induced by ICIs requires multidisciplinary cooperation among physicians. Furthermore, the underlying mechanisms are not fully understood and it is difficult to predict and evaluate these side effects precisely. In this review, we summarize available studies and findings about rheumatic irAEs, focusing mainly on the clinical manifestations, epidemiology, possible mechanisms, and guiding principles for treating these irAEs.

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Durvalumab-associated vasculitis presenting as ‘the blue toe syndrome’

Cited by 11 publications

References 21 publications

Immunotherapy in Elderly Patients Affected by Non-Small Cell Lung Cancer: A Narrative Review

Immunotherapy in Elderly Patients Affected by Non-Small Cell Lung Cancer: A Narrative Review

Rapidly progressing dyspnea and retiform purpura

Rheumatic Manifestations and Diseases From Immune Checkpoint Inhibitors in Cancer Immunotherapy

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