Ipilimumab induced digital vasculitis

Padda, Amrita; Schiopu, Elena; Sovich, Justin Lin; Ma, Vincent; Alva, Ajjai; Fecher, Leslie A.

doi:10.1186/s40425-018-0321-2

Cited by 38 publications

(20 citation statements)

References 19 publications

(15 reference statements)

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“…ICI-associated vasculitis can affect vessels of any size, [67][68][69][70][71][72][73] but has most commonly been reported in large vessels such as temporal (giant cell) arteritis and aortitis, according to a systematic review of case reports. 74 The over-representation of temporal arteritis reports among ICI users was also recently identified in a pharmacovigilance study.…”

Section: Ici-associated Vasculitismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year. Keywords Cardio-oncology • Immune checkpoint inhibitors • Myocarditis • Vasculitis • Pericarditis • Cardiovascular toxicity This article is part of the Spotlight Issue on Cardio-oncology.

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Section: Ici-associated Vasculitismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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“…There are case reports describing acral vasculitis with digital ischemia due to either an ir-AE or a paraneoplastic syndrome [62,[76][77][78][79]. Distinguishing ICI-induced vasculitis from paraneoplastic vasculitis can be very challenging, since the latter is sometimes concurrent with malignancies [80].…”

Section: Vasculitismentioning

confidence: 99%

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

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Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. Their clinical efficacy is well-documented, but the side effects associated with their use are still under investigation. These drugs cause several immune-related adverse events (ir-AEs), some of which stand within the field of rheumatology. Herein, we present a literature review performed in an effort to evaluate all publicly available clinical data regarding rheumatic manifestations associated with ICIs. The most common musculoskeletal ir-AEs are inflammatory arthritis, polymyalgia rheumatica and myositis. Non-musculoskeletal rheumatic manifestations are less frequent, with the most prominent being sicca, vasculitides and sarcoidosis. Cases of systemic lupus erythematosus or scleroderma are extremely rare. The majority of musculoskeletal ir-AEs are of mild/moderate severity and can be managed with steroids with no need for ICI discontinuation. In severe cases, more intense immunosuppressive therapy and permanent ICI discontinuation may be employed. Oncologists should periodically screen patients receiving ICIs for new-onset inflammatory musculoskeletal complaints and seek a rheumatology consultation in cases of persisting symptoms.

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“…Vasculitis induced by ICIs is rare, and mainly involves large vessels (giant cell arteritis, isolated aortitis) or the nervous system (primary angiitis of the central nervous system and isolated vasculitis of the peripheral nervous system) [ 3 ]. Moreover, acral vasculitis has been exceptionally reported before Padda et al report [ 1 , 3 – 5 ] (Table 1 ). The first case was a male patient, treated with a combination of anti-PD-L1 therapy, BRAF inhibitor and MEK inhibitor for metastatic melanoma, who developed severe finger ischemia with necrosis associated with positive cryoglobulin and auto-SSA ab [ 4 ].…”

Section: Main Textmentioning

confidence: 88%

“…In the February 2018 edition of the Journal for ImmunoTherapy of Cancer, Padda A. et al published an interesting case report of a 52-year old woman with a resected stage III B/C melanoma treated by high-dose of pilimumab (10 mg/kg) who developed severe digital ischemia [ 1 ]. Diagnosis of Ipilimumab-induced small vessel vasculitis was retained, requiring administration of high-dose corticosteroids, intravenous epoprostenol, botulinum toxin injections, and rituximab (weekly infusions, 375 mg/m2) for four cycles.…”

Section: Main Textmentioning

confidence: 99%

Immune checkpoint inhibitor-related acral vasculitis

Comont¹,

Sibaud²,

Mourey³

et al. 2018

j. immunotherapy cancer

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Commentary on « Ipilimumab induced vasculitis » by Padda A. et al., J Immunother Cancer. 2018;6:12. The authors diagnosed a small vessel vasculitis following treatment with anti-CTLA-4 (ipilimumab) for a resected stage III B/C melanoma. We report a similar case of acral vasculitis occurring with a combination of anti-CTLA-4 (tremelimumab) and anti-PD-L1 (durvalumab) prescribed for the management of a metastatic urothelial bladder cancer. In contrast to Padda A. et al., we observed a significant improvement with oral corticosteroids.

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Ipilimumab induced digital vasculitis

Cited by 38 publications

References 19 publications

Cardiovascular toxicities associated with immune checkpoint inhibitors

Cardiovascular toxicities associated with immune checkpoint inhibitors

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Immune checkpoint inhibitor-related acral vasculitis

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