Inflammatory Arthritis: A Newly Recognized Adverse Event of Immune Checkpoint Blockade

Naidoo, Jarushka; Cappelli, Laura C.; Forde, Patrick M.; Marrone, Kristen A.; Lipson, Evan J.; Hammers, Hans J.; Sharfman, William H.; Le, Dung T.; Baer, Alan N.; Shah, Ami A.; Albayda, Jemima; Manno, Rebecca L.; Haque, Uzma; Gutierrez, Anna Kristina; Bingham, Clifton O.; Brahmer, Julie R.

doi:10.1634/theoncologist.2016-0390

Cited by 75 publications

(45 citation statements)

References 38 publications

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“…Additionally, 2.7% of patients developed inflammatory arthritis, which may have additionally counfounded the survival results, although this relationship needs to be confirmed prospectively. However, the percentage of cases seems in line with the reported 1% to 7% seen in clinical trials .…”

Section: Discussionsupporting

confidence: 86%

The Impact of Nonsteroidal Anti-Inflammatory Drugs, Beta Blockers, and Metformin on the Efficacy of Anti-PD-1 Therapy in Advanced Melanoma

et al. 2019

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Anti–programmed cell death protein‐1 (anti‐PD‐1) therapy has greatly improved outcomes of patients with melanoma; however, many fail to respond. Although preclinical studies suggest a potentially synergistic relationship with anti‐PD‐1 therapy and certain concurrent medications, their clinical role remains unclear. Here, we retrospectively evaluated the use of nonsteroidal anti‐inflammatory drugs (NSAIDs) and other drugs in 330 patients with melanoma treated with anti‐PD‐1 therapy from four academic centers. In the cohort, 37% of patients used NSAIDs including aspirin (acetylsalicylic acid; ASA; 47%), cyclooxygenase (COX)‐2 inhibitors (2%), and non‐ASA/nonselective COX inhibitor NSAIDs (59%). The objective response rates (ORRs) were similar in patients with NSAID (43.4%) and no NSAID (41.3%) use with no significant difference in overall suvival (OS). There was a trend toward improved progression‐free survival (PFS) in patients who took NSAIDs (median PFS: 8.5 vs. 5.2 months; p = .054). Most patients (71.3%) took NSAIDs once daily or as needed. Multivariate analysis did not reveal an association with NSAID use with ORR, PFS, or OS. Concurrent use of metformin or beta blockers did not affect ORR, PFS, or OS. Our study found no conclusive association of concurrent NSAID or other medication use with improved outcomes in patients with melanoma treated with anti‐PD‐1 therapy. Larger and more systematic analysis is required to confirm these findings.

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Section: Discussionsupporting

confidence: 86%

The Impact of Nonsteroidal Anti-Inflammatory Drugs, Beta Blockers, and Metformin on the Efficacy of Anti-PD-1 Therapy in Advanced Melanoma

et al. 2019

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“…Prospective cohort studies and retrospective reviews report the incidence of IA or other rheumatologic irAEs among patients receiving ICIs to be between 1% and 7%. 67,[209][210][211] Among a prospective cohort study of 524 patients receiving ICIs, 35 (6.6%) were referred to rheumatology. 67 Twenty patients had IA that presented similar to rheumatoid arthritis (n57), polymyalgia rheumatica (n511), or psoriatic arthritis (n52), while the remaining 15 patients were diagnosed with noninflammatory musculoskeletal conditions.…”

Section: Musculoskeletal Toxicitymentioning

confidence: 99%

Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology

Thompson

Schneider

Brahmer

et al. 2019

Journal of the National Comprehensive Cancer Network

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437

332

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The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visit NCCN.org.

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“…Inflammatory arthritis has been reported in 1% to 7%, occurring more often with combination therapy. 10,25,26 Arthritis usually develops with other irAEs, occurs after 5 months of therapy, and can affect large, medium, or small joints. 10 It may be destructive and persist after discontinuation of immunotherapy.…”

Section: Endocrine Toxicitiesmentioning

confidence: 99%

Immune Checkpoint Inhibitor Toxicities

Marin-Acevedo

Chirilă

Dronca

2019

Mayo Clinic Proceedings

109

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Inflammatory Arthritis: A Newly Recognized Adverse Event of Immune Checkpoint Blockade

Cited by 75 publications

References 38 publications

The Impact of Nonsteroidal Anti-Inflammatory Drugs, Beta Blockers, and Metformin on the Efficacy of Anti-PD-1 Therapy in Advanced Melanoma

The Impact of Nonsteroidal Anti-Inflammatory Drugs, Beta Blockers, and Metformin on the Efficacy of Anti-PD-1 Therapy in Advanced Melanoma

Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology

Immune Checkpoint Inhibitor Toxicities

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