Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma

Spathas, Nikolaos; Economopoulou, Panagiota; Cheila, Myrto; Kotsantis, Ioannis; Fanouriakis, Antonis; Kassara, Dimitra; Psyrri, Amanda

doi:10.3389/fonc.2018.00409

Cited by 14 publications

(6 citation statements)

References 17 publications

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“…In a recent systematic review and metaanalysis of studies performed on cancer patients receiving anti-PD-1 and anti-PDL1 agents, only few individual cases of arthritis were reported at a rate below 1%. However, across the groups, musculoskeletal complaints were very common, ranging from 9 to 18% for arthralgia, 2 to 16% for back pain, 4 to 6% for musculoskeletal pain, and 4 to 16% for myalgia, suggesting that organ specific immune adverse events are uncommon with anti-PD-1 drugs, yet they are associated with a higher risk compared to control treatments (8,9). The pathophysiology of pembrolizumabinduced inflammatory arthritis has not yet been clarified.…”

Section: N Discussion and Conclusionmentioning

confidence: 99%

Case report of polymyalgia rheumatica in a male patient with three different neoplasms treated with pembrolizumab

et al. 2020

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In this manuscript we aim to describe a particular case of a 63 years-old man who developed three different malignancies (one was a rare case of breast cancer) among nearly five years. In particular, for the diagnosis of melanoma, he was treated with pembrolizumab, a PD-1 inhibitor. After few months of treatment with pembrolizumab, the patient reported the onset of musculoskeletal symptoms such as inflammatory pain at the shoulders and morning stiffness, with raised CRP and ESR and imaging evidence of bursitis and tenosynovitis. A polymyalgia-like syndrome was diagnosed. Understanding if these manifestations are linked to the use of pembrolizumab or to a paraneoplastic syndrome, and how to manage the patient, was the real challenge.

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Section: N Discussion and Conclusionmentioning

confidence: 99%

Case report of polymyalgia rheumatica in a male patient with three different neoplasms treated with pembrolizumab

et al. 2020

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“…The patient’s quality of life was severely affected due to her extensive psoriatic lesions, even though she had no evidence of metastatic disease or recurrence of NSCLC. The etiology of psoriasis and other autoimmune adverse events secondary to immunotherapy is said to be due to T-cell activation-enhanced autoimmunity [3].…”

Section: Discussionmentioning

confidence: 99%

A Novel Approach to the Treatment of Pembrolizumab-induced Psoriasis Exacerbation: A Case Report

Monsour¹,

Pothen²,

Balaraman³

2019

Cureus

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While immune checkpoint inhibitors have been groundbreaking for cancer treatment, there are many reported cases of patients undergoing immunotherapy who have discontinued or temporarily interrupted treatment due to the development of autoimmune-related adverse effects. Here, we present a 63-year-old female with a history of psoriasis (in spontaneous remission) and newly diagnosed poorly differentiated lung adenocarcinoma (pTXN3M1a) who experienced a severe flare-up of her psoriasis three months after initiating single-agent pembrolizumab. The patient was initially treated with topical clobetasol propionate ointment, however, due to minimal response to this regimen, the patient was commenced on secukinumab; an IL-17 inhibitor. To our knowledge, this is the first case of the successful use of secukinumab for the treatment of immunotherapy-induced psoriasis. More importantly, immunotherapy with pembrolizumab was continued successfully with the co-administration of secukinumab without complications or the recurrence of non-small cell lung cancer (NSCLC).

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“…Also, acute and delayed onset inflammatory polyarthritis after treatment with pembrolizumab have been reported. 18,19 However, there is no anti-VEGF therapy-induced RS3PE or arthritis cases have been reported yet. At present, main treatment of RS3PE is corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab- and/or pazopanib-induced remitting seronegative symmetrical synovitis with pitting edema in a patient with renal cell carcinoma

Bas

Ozbek

Güven

et al. 2019

J Oncol Pharm Pract

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Introduction Immune checkpoint inhibitors and angiogenesis inhibitors are novel treatment options for renal cell carcinoma and widely used in clinical practice. They are related with adverse events that occur as a consequence of immune system activation and inhibition of angiogenesis. Herein, we report a rare case of inflammatory arthritis seen in a patient treated with an anti Programmed cell death-1 pembrolizumab and an anti-vascular endothelial growth factor pazopanib. Case report A 60-year-old Caucasian male presented to our clinic with inflammatory arthritis with pitting edema. He had been started on pembrolizumab therapy for metastatic renal cell carcinoma after enrolling in the KEYNOTE-679 study. After six cycles of treatment with pembrolizumab, metastasis had been determined in the lung. Then, the patient’s therapy was changed to pazopanib. While the patient was on pazopanib treatment, he noticed a gradual swelling of both hands. Rheumatoid factor, anti-nuclear antibody and anti-cyclic citrullinated peptide were negative. Joint ultrasonography revealed acute tenosynovitis and soft tissue swelling with pitting edema, and a diagnosis of remitting seronegative symmetrical synovitis with pitting edema was made. Management and outcome: He was started on 10 mg prednisolone daily. His symptoms dramatically responded to corticosteroid. He continued to take pazopanib. Then, the patient was discharged with 10 mg prednisolone daily. Discussion Pembrolizumab- and/or pazopanib-induced remitting seronegative symmetrical synovitis with pitting edema can be among the rare rheumatic immune-related adverse events that clinicians may encounter as the immune check point inhibitors and anti-VEGF use increases. Corticosteroid therapy can relieve symptoms and cessation of therapy may not be necessary.

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Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma

Cited by 14 publications

References 17 publications

Case report of polymyalgia rheumatica in a male patient with three different neoplasms treated with pembrolizumab

Case report of polymyalgia rheumatica in a male patient with three different neoplasms treated with pembrolizumab

A Novel Approach to the Treatment of Pembrolizumab-induced Psoriasis Exacerbation: A Case Report

Pembrolizumab- and/or pazopanib-induced remitting seronegative symmetrical synovitis with pitting edema in a patient with renal cell carcinoma

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