Vasculitis associated with immune checkpoint inhibitors—a systematic review

Daxini, Anisha; Cronin, Keri; Sreih, Antoine

doi:10.1007/s10067-018-4177-0

Cited by 215 publications

(144 citation statements)

References 33 publications

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“…More rarely, immune‐related peripheral neuropathies may manifest as isolated cranial neuropathies, lumbar or brachial plexopathy, enteric plexus neuropathy, or peripheral nervous system vasculitis …”

Section: Clinical Syndromes and Presentationsmentioning

confidence: 99%

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Psimaras

Velasco

Birzu

et al. 2019

J Peripheral Nervous Sys

122

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Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumor types. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PD-L1, and anti-CTLA-4 treatment, and include myositis, myasthenia gravis, and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment.Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multi-disciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange, and other immune-modulating treatments should be considered in more severe cases. Consideration of re-challenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs. K E Y W O R D SCTLA-4, demyelinating polyradiculoneuropathy, immune checkpoint inhibitor, myasthenia gravis, myositis, nivolumab, PD-1, PD-L1, pembrolizumab, peripheral neuropathy

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Section: Clinical Syndromes and Presentationsmentioning

confidence: 99%

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Psimaras

Velasco

Birzu

et al. 2019

J Peripheral Nervous Sys

122

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“…Granulomatous reactions are a rare subset of IRAEs that develop in response to checkpoint inhibition. An extensive literature search found several articles documenting cases of granulomatous IRAEs . Many of these cases were diagnosed as sarcoidosis in response to ipilimumab monotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…On average, the cutaneous eruption resolved 21 weeks after therapy discontinuation . In terms of vasculitis, to date, there have been 20 confirmed cases of vasculitis associated with immune‐checkpoint inhibitors . Of these cases, one was diagnosed as granulomatous vasculitis in response to ipilimumab …”

Section: Discussionmentioning

confidence: 99%

“…These include but are not limited to the upregulation of T‐cell activity against antigens present in both healthy and diseased tissues and enhancement of complement‐mediated inflammation due to antibody binding to PD‐1, PDL‐1, and CTLA‐4 . Specifically, there is research implicating that a deficiency of PD‐1, which could be caused by medication, may remove checkpoints that lead to an uninhibited release of T‐cells, which may go on to attack arteries . As immunomodulatory checkpoint therapies are used more frequently and for a larger array of malignancies, the understanding and documentation of IRAEs will become increasingly important.…”

Section: Discussionmentioning

confidence: 99%

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Interstitial granulomatous dermatitis and granulomatous arteritis in the setting of PD‐1 inhibitor therapy for metastatic melanoma

et al. 2019

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Checkpoint inhibition has become an important target in the management of malignant melanoma. As anti-CTLA4 inhibitors and anti-PD1 antibodies are increasingly utilized, reports of immune-related adverse events (IRAEs) are becoming more frequent. Common noted cutaneous IRAEs are morbilliform, lichenoid, bullous, granulomatous, psoriasiform, and eczematous eruptions. We report a case of interstitial granulomatous dermatitis and granulomatous arteritis in the setting of nivolumab (anti-PD1) monotherapy for metastatic melanoma. There are many different causes for granulomatous vasculitis, such as herpes virus infection, lymphoproliferative disorders, systemic vasculitis, and inflammatory bowel disease. This report adds to the growing literature on granulomatous IRAEs due to checkpoint inhibition. K E Y W O R D S checkpoint inhibitors, granulomatous vasculitis, immune-related adverse events, interstitial granulomatous dermatitis, nivolumab

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“…In a recent systematic review of all rheumatic adverse events caused by ICPis, vasculitis was reported in two clinical trials, and reports were otherwise limited to case reports . Another review identified 53 cases of vasculitis associated with the use of an ICPi, of which 20 were confirmed cases . Small‐, medium‐, and large‐vessel vasculitides affecting numerous organs including the skin, large vessels, and peripheral nerves have been reported .…”

Section: Rheumatic Toxicitymentioning

confidence: 99%

Diagnosis and Management of Rare Immune-Related Adverse Events

et al. 2019

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Oncologic treatment is being revolutionized by a burgeoning number of immune checkpoint inhibitors (ICPis). To date, seven ICPis have received Food and Drug Administration approval, targeting cytotoxic T-lymphocyte antigen, programmed cell death, or programmed cell death ligand. Adverse events associated with checkpoint inhibition have been described in the literature. Guidelines exist for the most common of these, but as the use of ICPis becomes more common, the number of patients presenting with rare events will increase. This article reviews the diagnosis and management of rare ocular, hematological, luminal gastrointestinal, and rheumatological toxicities arising from ICPi treatment. The Oncologist 2020;25:6-14 KEY POINTS• As the use of immune checkpoint inhibitors (ICPis) becomes more common, the number of rare immune-related adverse events (irAEs) will increase. A high level of suspicion is required to identify and treat these toxicities. • Although it can be difficult to definitively attribute rare irAEs to ICPis, a temporal and mechanistic relationship and the absence of other etiologies should make the treating physician suspicious for a rare irAE. • Certain rare irAEs, such as celiac disease, do not require treatment with glucocorticoids. Thus, differentiating this irAE from other gastrointestinal irAEs has important implications for treatment.

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Vasculitis associated with immune checkpoint inhibitors—a systematic review

Cited by 215 publications

References 33 publications

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

Interstitial granulomatous dermatitis and granulomatous arteritis in the setting of PD‐1 inhibitor therapy for metastatic melanoma

Diagnosis and Management of Rare Immune-Related Adverse Events

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