Advanced Lung Adenocarcinoma with Nivolumab-associated Dermatomyositis

Kudo, Fumiaki; Watanabe, Yasutaka; Iwai, Yasuhiro; Miwa, Chihiro; Nagai, Yoshinori; Ota, H.; Yabe, Hiroki; Demitsu, Toshio; Hagiwara, Koichi; Koyama, Nobuyuki; Koyama, Shinichiro

doi:10.2169/internalmedicine.9381-17

Cited by 39 publications

(18 citation statements)

References 17 publications

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“…Onset of symptoms tended to occur later than with other Rh‐irAEs, and prolonged immunosuppressive treatment was typically required, with few patients achieving complete symptom resolution (Table ). In general, vasculitis and CTD observed in conjunction with ICI therapy are less commonly reported, with the literature being limited to case reports and small series . As such, the optimal treatment of these patients and the impact on overall survival remain entirely unknown.…”

Section: Discussionmentioning

confidence: 99%

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

Richter

Crowson

Kottschade

et al. 2019

Arthritis & Rheumatology

111

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Objective To describe the prevalence, clinical presentation, and management of rheumatic immune‐related adverse effects (Rh‐irAEs) from immune checkpoint inhibitor (ICI) therapy. Methods From a database of all patients who received any ICI at the Mayo Clinic Rochester, Minnesota campus between January 1, 2011 and March 1, 2018, we retrospectively identified those with Rh‐irAEs, using diagnostic codes, search terms, and manual chart review. Results Of the 1,293 patients who received any ICI, Rh‐irAEs were clinically diagnosed in 43. Eighteen patients with Rh‐irAEs who received ICI therapy elsewhere were also analyzed. Clinical syndromes included inflammatory arthritis (n = 34 [prevalence 2%]), myopathy (n = 10), and other rheumatic syndromes (n = 17). Inflammatory arthritis was most commonly polyarticular, and glucocorticoid treatment was required in 26 patients (76%). The mean ± SD duration of treatment was 18 ± 18 weeks. Five patients (15%) also received disease‐modifying antirheumatic drugs, and ICI therapy had to be discontinued in 3 patients (9%). Myopathy was treated with glucocorticoids in all cases (mean ± SD treatment duration 15 ± 17 weeks) and led to 2 deaths and permanent ICI discontinuation in 9 patients (90%). Other syndromes included connective tissue diseases, vasculitis, polymyalgia rheumatica–like syndrome, and flare of preexisting rheumatic disease. Most (71%) were treated with immunosuppression, with 12% requiring ICI discontinuation. Conclusion This study represents the largest cohort of patients with Rh‐irAEs reported to date. Most patients received long courses of immunosuppressive treatment, although discontinuation of ICI therapy was required in only a minority.

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Section: Discussionmentioning

confidence: 99%

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

Richter

Crowson

Kottschade

et al. 2019

Arthritis & Rheumatology

111

View full text Add to dashboard Cite

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“…Although various autoimmune-related adverse events related to nivolumab have been reported, nivolumab-triggered dermatomyositis, apart from myositis, is rare and there is only one case in the literature, as far as we know. Kudo et al reported the case of a patient who was treated with nivolumab for his advanced lung adenocarcinoma and was diagnosed as having nivolumab-associated dermatomyositis from his symptoms and his examinations [17]. They proposed it is necessary to consider drug-associated dermatomyositis even after nivolumab therapy [17].…”

Section: Discussionmentioning

confidence: 99%

“…Kudo et al reported the case of a patient who was treated with nivolumab for his advanced lung adenocarcinoma and was diagnosed as having nivolumab-associated dermatomyositis from his symptoms and his examinations [17]. They proposed it is necessary to consider drug-associated dermatomyositis even after nivolumab therapy [17]. In our case, however, our patient was finally diagnosed not as having nivolumab-induced myositis but as having paraneoplastic dermatomyositis because of the time course of redness of skin and the high anti-TIF1-γ antibody titer.…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic dermatomyositis appearing after nivolumab therapy for gastric cancer: a case report

et al. 2019

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Background While dermatomyositis is often associated with malignancy, several autoimmune diseases like myositis can be caused by immune checkpoint inhibitors. Differentially diagnosing malignancy-associated dermatomyositis or myositis caused by immune checkpoint inhibitors is sometimes difficult, particularly when a patient with malignancy shows the symptoms of myositis after checkpoint inhibitor administration. We experienced such a case in which we had difficulties in diagnosing paraneoplastic dermatomyositis or drug-associated myositis. In this case, all of our team initially assumed that the diagnosis was myositis caused by immune checkpoint inhibitors. However, it turned out finally that the diagnosis was paraneoplastic dermatomyositis. Because the diagnosis was unexpected, we report here. Case presentation We report the case of a 71-year-old Japanese man who developed clinical symptoms of myositis, such as muscle aches and weakness, after initiation of nivolumab therapy for his gastric cancer. He was initially diagnosed with nivolumab-induced myositis, because the myositis symptoms appeared after nivolumab administration, and nivolumab is known to trigger various drug-associated autoimmune diseases. However, according to his characteristic skin lesions, the type of muscle weakness, his serum marker profiles, electromyography of his deltoid muscle, and magnetic resonance imaging, he was finally diagnosed as having paraneoplastic dermatomyositis. Accordingly, treatment with intravenously administered corticosteroid pulse treatment, immunoglobulin injection, and tacrolimus was applied; his symptoms subsequently improved. However, to our regret, at day 142 after administration, he died due to rapid worsening of his gastric cancer. Conclusion Differentially diagnosing paraneoplastic dermatomyositis or drug-associated myositis caused by immune checkpoint inhibitors is difficult in some cases. The differential diagnosis is crucial because it influences the decision regarding the appropriateness of the use of immunosuppressive treatment against the autoimmune diseases as well as the decision regarding the appropriateness of the continuous use of immune checkpoint inhibitors against the primary cancers. Because subclinical autoimmune disease may become overt after administering immune checkpoint inhibitors, non-apparent autoimmune diseases, which have already existed, should also be considered to avoid the delay of appropriate treatment, when symptoms of autoimmune diseases are recognized.

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“… 1 , 2 There is 1 report of an inflammatory myopathy complicating nivolumab therapy that was described as dermatomyositis sine dermatitis and 1 case of dermatomyositis with classic cutaneous features induced by nivolumab. 4 , 5 However, there are no reports of Wong-type dermatomyositis during anti–PD-1 therapy. Wong-type dermatomyositis is a rare variant of dermatomyositis with fewer than 30 cases reported.…”

Section: Discussionmentioning

confidence: 99%