Immune-Related Adverse Effects of Cancer Immunotherapy— Implications for Rheumatology

Abstract

Summary Immune checkpoint inhibitors (ICIs) are being increasingly studied and used as therapy for a growing number of malignancies. ICIs work by blocking inhibitory pathways of T-cell activation, leading to an immune response directed against tumors. Such nonspecific immunologic activation can lead to immune-related adverse events (IRAE). Some IRAE including inflammatory arthritis, sicca syndrome, myositis and vasculitis are of special interest to rheumatologists. As use of ICIs increases, recognition of these IRAEs and developing treatment strategies will become important. In this review, the current literature on rheumatic and musculoskeletal IRAEs is summarized. The incidence, clinical presentations, and treatment considerations are highlighted.

Brief Report: Cancer Immunotherapy in Patients With Preexisting Rheumatic Disease: The Mayo Clinic Experience

“…Of these events, 2 were graded as mild, and all 6 patients responded well to glucocorticoids. This is consistent with what is currently known about the management of IRAEs . Furthermore, we found no association between DMARD use, either before or during ICI therapy, and the risk of development of an IRAE.…”

Rheumatic Syndromes Associated With Immune Checkpoint Inhibitors: A Single‐Center Cohort of Sixty‐One Patients

“…Vasculitis cases included necrotizing vasculitis, GPA flare, and giant cell arteritis flare (patients 1-4). There was 1 case of PMR flare and 3 cases of new-onset PMR-like syndrome (patients [5][6][7][8]. CTD included cases of diffuse systemic sclerosis-like syndrome and sicca syndrome (patients [9][10][11][12][13][14].…”

Review: Immune‐Related Adverse Events With Use of Checkpoint Inhibitors for Immunotherapy of Cancer

“…At face value, it appears likely that the prevalence of arthritis might be underrepresented, because most oncology clinical trial publications report primarily grade 3 or higher adverse events, and arthritis may not be considered as severe as other AEs (32). At face value, it appears likely that the prevalence of arthritis might be underrepresented, because most oncology clinical trial publications report primarily grade 3 or higher adverse events, and arthritis may not be considered as severe as other AEs (32).…”