Immune checkpoint inhibitor-related acral vasculitis

Comont, T.; Sibaud, V.; Mourey, Loïc; Cougoul, P.; Beyne-Rauzy, Odile

doi:10.1186/s40425-018-0443-6

Cited by 34 publications

(18 citation statements)

References 5 publications

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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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Section: Vasculitismentioning

confidence: 99%

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

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“…The use of calcium channel blockers, prostaglandins and sympathectomy reported in different cases have all been unsuccessful [1, 7]. Glucocorticoids showed variable outcomes from complete resolution of the ischemia to partial or no response [1, 8]. Rituximab was reported to be beneficial in one case and to halt the progression of acral necrosis, but the patient required digital amputation eventually [7].…”

Section: Resultsmentioning

confidence: 99%

“…Some literature regarding digital ischemia favors autoimmune involvement during treatment with ICIs. As an example, Comont et al described a case of acral necrosis during combined treatment with CTLA-4 and PD-L1 inhibitors that was associated with increased titers of ANA (1:5200) which would support an autoimmune etiology [8]. In this case, there was a complete reversal of the acral ischemia with high suppressive dose of prednisone (1 mg/kg daily) [8].…”

Section: Resultsmentioning

confidence: 99%

“…As an example, Comont et al described a case of acral necrosis during combined treatment with CTLA-4 and PD-L1 inhibitors that was associated with increased titers of ANA (1:5200) which would support an autoimmune etiology [8]. In this case, there was a complete reversal of the acral ischemia with high suppressive dose of prednisone (1 mg/kg daily) [8]. However, the patient of the previous study received chemotherapy prior to ICI includeding methotrexate, vinblastine, doxorubicin and cisplatin which could be culprits in acral necrosis.…”

Section: Resultsmentioning

confidence: 99%

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Acral vascular necrosis associated with immune-check point inhibitors: case report with literature review

Khaddour

Singh²,

Shayuk

2019

BMC Cancer

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Background Treatment of solid malignancies has been revolutionized with the introduction of immune checkpoint inhibitors (ICIs) and their use is being expanded in therapy of different cancers. However, immune related adverse events (IRAEs) can occur during treatment. These side effects occur due to stimulation of the innate and adaptive immune system and can lead to serious complications. Recently, acral ischemia has been reported in some cases during treatment with programmed death-1 (PD-1) and cytotoxic T lymphocyte associated antigen-4 (CTLA-4) inhibitors. Here, we discuss a case in which acral necrosis developed after initiation of a PD-1 inhibitor. We offer a review of the existing literature on the pathophysiology, clinical course and treatment outcomes. Case presentation A 68-year-old female was diagnosed with stage IV non-small cell lung adenocarcinoma and was started on pembrolizumab. The patient developed sudden onset numbness and discoloration of fingertips bilaterally at week 25 after initiation of ICI treatment. Extensive workup to rule out hypercoagulable, autoimmune and vascular disease was unremarkable except for mild elevation of ANA and ESR. The symptoms quickly progressed into dry gangrene within four weeks and did not respond to medical or surgical treatment. Pembrolizumab was subsequently discontinued due to progression of metastatic disease. The patient refused further interventions and transitioned to hospice care where she expired after two months. Conclusion Acral ischemia can develop during treatment of malignancies. This complication, although uncommon, canresult in digital amputation. Physicians should be aware of the possible progression of acral vascular necrosis when Raynaud’s like symptoms develop. Larger studies are needed to confirm the role of ICIs in the pathogenesis of acral vascular necrosis.

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“…Patients experiencing CPI-induced vasculitis presented with various clinical manifestations, including arthralgia, arthritis, myalgia, purpura, digital necrosis, fever, fatigue and abdominal pain. The corresponding diagnosis are cutaneous leucocytoclastic vasculitis [49], acral vasculitis [10, 50, 51], granulomatosis with polyangiitis [52], eosinophilic granulomatosis with polyangiitis [53], cryoglobulinemic vasculitis [44], giant cell arthritis [54–56] and a large proportion of cases are reported as vasculitis [7, 57, 58].…”

Section: Vasculitismentioning

confidence: 99%

Clinical characteristics of rheumatic syndromes associated with checkpoint inhibitors therapy

2019

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Compared with conventional cancer therapies, the spectrum of toxicities observed with checkpoint inhibitors is unique and can affect any organ system. Arthralgia and myalgia were by far the most commonly reported rheumatic immune-related adverse events in clinical trials, and there is now a growing number of case series and reports describing clinical features of de novo rheumatic immune-related adverse events, which will be the focus of this review. Some patients develop genuine classic rheumatic and musculoskeletal diseases, but a number of rheumatic immune-related adverse events mimic rheumatic and musculoskeletal diseases with atypical features, mainly polymyalgia rheumatica, rheumatoid arthritis and myositis, as well as several systemic conditions, including sicca syndrome, vasculitis, sarcoidosis, systemic sclerosis and lupus.

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Immune checkpoint inhibitor-related acral vasculitis

Cited by 34 publications

References 5 publications

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Acral vascular necrosis associated with immune-check point inhibitors: case report with literature review

Clinical characteristics of rheumatic syndromes associated with checkpoint inhibitors therapy

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