Immunotherapy-intensified paraneoplastic dermatomyositis

Estenaga, Ángela; Rodríguez‐Garijo, Nuria; Tomás‐Velázquez, Alejandra; Antoñanzas, Javier; Alvarez-Gigli, M L; García-Tobar, Laura; Espaa-Alonso, A; Salido‐Vallejo, Rafael

doi:10.25259/ijdvl_1306_20

Cited by 13 publications

(7 citation statements)

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“…These scores may be skewed lower given the number of cases with cancer as a possible cause for DM. Reference lists of 114 eligible articles revealed 20 additional articles that were included. Among 134 articles, data from 165 patients were included in the systematic review (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Causes and Clinical Presentation of Drug-Induced Dermatomyositis

Caravan,

Lopez,

Yeh

2024

JAMA Dermatol

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ImportanceWhile several medications are known to induce dermatomyositis (DM), most existing studies are case reports or small case series from a single institution. There is also limited information on DM induced by immune checkpoint inhibitors, which are increasingly used in oncologic therapy.ObjectiveTo characterize causes and clinical presentation of drug-induced DM based on the current literature.Evidence ReviewA systematic review was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, from inception to August 22, 2022. Articles meeting preestablished inclusion criteria (written in English and classified as original articles, case reports, literature reviews, and observation letters) were selected and data abstracted. Articles that met the scope of the review were also added from reference lists. When possible, study results were quantitatively combined.FindingsIn 134 studies (114 from the literature search and 20 additional studies pulled from reference lists) describing 165 cases, 88 patients (53.3%) were female, and the median (IQR) age was 61 (49-69) years. Among the cases of drug-induced DM, the most common associated medications were hydroxyurea (50 [30.3%]), immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and tumor necrosis factor inhibitors (10 [6.1%]). Histopathologic testing, when undertaken, helped establish the diagnosis. There was a median (IQR) of 60 (21-288) days between drug initiation and drug-induced DM onset. History of cancer was reported in 85 cases (51.6%).Conclusions and RelevanceIn this systematic review, drug-induced DM was associated with multiple types of medications, including chemotherapies and immunotherapies. It is essential that dermatologists promptly recognize and diagnose drug-induced DM so that they can guide management to minimize interruption of therapy when possible.

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Section: Resultsmentioning

confidence: 99%

Causes and Clinical Presentation of Drug-Induced Dermatomyositis

Caravan,

Lopez,

Yeh

2024

JAMA Dermatol

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“…Interestingly, to the best of our knowledge, there is only a single published case of DM that resulted in disease resolution following treatment with immunotherapy [ 32 ]. The large majority of cases report DM as an adverse effect of ICI (pembrolizumab -carcinoma of unknown origin, squamous cell carcinoma of lung and lung adenocarcinoma; atezolizumab-in small cell lung cancer and non-small-cell lung cancer; nivolumab- lung adenocarcinoma and ipilimumab- small-cell lung cancer) [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Bendewald et al have reported that the estimated incidence of DM is 9.63 cases per million people [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Dermatomyositis Associated with Lung Cancer: A Brief Review of the Current Literature and Retrospective Single Institution Experience

Shalata

Zolnoorian

Meirovitz

et al. 2022

Life

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Dermatomyositis is a rare inflammatory myopathy that is often related to lung cancer. In this retrospective observational study, we analyzed data from patients diagnosed with lung cancer at Soroka University Medical Center between January 2017 and July 2021. A total of 689 patients with lung cancer were included in this study, 97 of whom had small cell lung cancer and 592 had non-small cell lung cancer. We identified a single patient (60-year-old female) who presented with signs and symptoms of dermatomyositis, which was later confirmed to be associated with lung cancer as a paraneoplastic syndrome. Both our study and a recent review of the literature illustrate the temporal link between dermatomyositis and lung cancer, as well as reinforce the need for heightened cancer screenings in DM patients.

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“…Анализируя наш опыт и опыт других исследователей, можно заключить, что текущее понимание природы и особенностей скелетно-мышечных иНЯ не позволяет ответить на вопрос, можно ли рассматривать их как вариант идиопатических воспалительных скелетно-мышечных заболеваний или же как отдельную нозологическую единицу? Кроме того, при отсутствии специфических диагностических тестов зачастую сложно провести границу между иНЯ и паранеопластическими синдромами, которые имеют клиническое сходство с иНЯ и могут дебютировать или обостряться у пациентов, получающих ИКТ [17][18][19].…”

Section: показатель результатunclassified

The Debut of Inflammatory Musculoskeletal Pathology in Patients Receiving Anticancer Therapy with PD-1/PD-L1 Pathway Inhibitors

Koltakova¹,

Лила²,

Alekseeva³

et al. 2022

Sovremennaâ revmatologiâ

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Objective: to describe musculoskeletal immune-mediated adverse events (iAEs) associated with the therapy of solid tumors with immune checkpoint inhibitors (ICIs, inhibitors of the PD-1/PD-L1 pathway).Patients and methods. 13 patients receiving ICIs therapy with musculoskeletal iAEs were examined. The average age of patients was 59±10 years. All cases had a histologically verified diagnosis of a malignant solid neoplasm: melanoma (n=5), kidney cancer (n=3), bladder cancer (n=2), non-small cell lung cancer (n=1), breast cancer (n=1), cervical cancer (n=1). All patients were prescribed inhibitors of the PD-1/PD-L1 signaling pathway: nivolumab (n=6), pembrolizumab (n=3), atezolizumab (n=3), prolgolimab (n=1). In 7 (54%) patients, in addition to musculoskeletal disorders, other AEs were also detected: thyroiditis (n=3), neuropathy (n=2), rash (n=1), dry syndrome (n=1), hepatitis (n=1). The median time from the start of antitumor immunotherapy (IT) to the onset of musculoskeletal pathology was 20 [9; 48] weeks.Results and discussion. Clinical manifestations of musculoskeletal pathology included: synovitis in 9 (69%) patients, tenosynovitis in 11 (85%), enthesitis in 4 (31%), morning stiffness in the joints for more than 30 minutes in 4 (31%). In 11 cases, musculoskeletal pathology was persistent (in 9 patients with arthritis and 2 with periarthritis) and in 2 – transient. The knee (77%), shoulder (69%) and hand (54%) joints were most frequently affected, with bilateral involvement in 9 (69%) patients. Inflammatory changes in the joints were represented by mono- (n=1), oligo- (n=3) and polyarthritis (n=5), including those involving the small joints of the hands and/or feet (n=5) and predominantly affecting the joints of the lower limbs (n=3). In 3 patients with arthritis, periarticular changes dominated in clinical picture (in 2 patients with symmetrical polyarthritis and severe tenosynovitis, in another 1 patient – with RS3PE syndrome). The severity of musculoskeletal pathology was assessed using the CTCAE v5.0 toxicity criteria: grade 1 was documented in 2 (15.5%), grade 2 in 9 (69%), and grade 3 in 2 (15, 5%) patients. Laboratory workup revealed elevation of ESR ≥30 mm/h (median – 34 [14; 42] mm/h) in 7 out of 12 (58%) patients, elevation of CRP level >5 mg/l (median – 7.2 [4.6; 12.9] mg/l) – in 7 out of 10 (70%). In 7 out of 10 patients, antinuclear antibodies (Hep2) were detected in titers: 1:160 (n=2), 1:320 (n=3), 1:640 (n=2). Rheumatoid factor and antibodies to cyclic citrullinated peptide were not detected in any case. Therapy for musculoskeletal AEs included non-steroidal anti-inflammatory drugs (n=10), oral systemic glucocorticoids – GC (n=5), methotrexate – MT (n=1) and hydroxychloroquine (n=5), intra-articular administration of GC (n=1). Five patients with arthritis required long-term therapy (median duration – 12 [3; 12] months), in 1 patient with polyarthritis and severe tenosynovitis, antitumor IT was interrupted for the duration of the course of MTX treatment.Conclusion. It has been shown that musculoskeletal iAEs have heterogeneous manifestations and may require long-term treatment and in rare cases, anticancer therapy interruption. Additional studies and close cooperation between rheumatologists and oncologists are needed to obtain a more complete understanding of the nature and spectrum of musculoskeletal AEs, to identify their clinical, laboratory and instrumental features, and to develop an management of patients algorithm.

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Immunotherapy-intensified paraneoplastic dermatomyositis

Cited by 13 publications

References 13 publications

Causes and Clinical Presentation of Drug-Induced Dermatomyositis

Causes and Clinical Presentation of Drug-Induced Dermatomyositis

Dermatomyositis Associated with Lung Cancer: A Brief Review of the Current Literature and Retrospective Single Institution Experience

The Debut of Inflammatory Musculoskeletal Pathology in Patients Receiving Anticancer Therapy with PD-1/PD-L1 Pathway Inhibitors

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