Rheumatic immune-related adverse events associated with cancer immunotherapy: A nationwide multi-center cohort

Roberts, Janet; Ennis, Daniel B.; Hudson, Marie; Ye, Carrie; Saltman, Alexandra; Himmel, Megan E.; Rottapel, Robert; Pope, Janet; Hoa, Sabrina; Tisseverasinghe, Annaliese; Fifi‐Mah, Aurore; Maltez, Nancy; Jamal, Shahin

doi:10.1016/j.autrev.2020.102595

Cited by 53 publications

(51 citation statements)

References 30 publications

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“…Rheumatologic irAEs are common and well described in the current literature. While arthralgia, myalgia, arthritis and myositis are some of the most common musculoskeletal rheumatic manifestations, scleroderma and scleroderma-like cases related to CPIs are only rarely described among the non-musculoskeletal rheumatic irAEs [2][3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

2020

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Immune checkpoint inhibitors are a promising new therapeutic strategy in oncology that aims to eliminate cancer cells by enhancing patients' immune response against tumor antigens. Despite their beneficial effects, immune checkpoint inhibitors are also responsible for a plethora of autoimmune manifestations, known as immune-related adverse events. We present a case of eosinophilic fasciitis-like disorder in an 81-year-old patient treated with the programmed death cell protein 1 inhibitor pembrolizumab for non-small-cell lung cancer. The patient developed characteristic indurated skin lesions in his limbs after 1½ years of treatment with pembrolizumab and a typical “groove sign.” Raynaud’s syndrome was absent. A full-thickness biopsy confirmed the clinical diagnosis of an “EF-like” condition. Neither peripheral eosinophilia nor eosinophilic infiltrates in the skin biopsy were found. His symptoms improved after a 2.5-month CPI discontinuation and treatment with 16 mg of methylprednisolone slowly tapered to a dose of 4 mg. Eosinophilic fasciitis is a rare immune-related adverse event of CPI treatment; our literature search identified only 12 cases that fulfill the criteria of EF in patients receiving CPIs.

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Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

2020

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“…Approximately half of all patients have lingering symptoms of arthritis lasting at least 6–12 months after discontinuation of an ICI that, in our experience, will evolve into a truly chronic condition in a subset 96 . Furthermore, the response to steroids is often suboptimal in both the acute and chronic setting, as data from one series indicate that two thirds of patients require disease-modifying antirheumatic drugs (DMARDs) 97 . Notably, these data also suggest that the use of steroids and DMARDs is not associated with a worsening of oncological outcomes 97 .…”

Section: Chronic Iraesmentioning

confidence: 99%

Immune-checkpoint inhibitors: long-term implications of toxicity

et al. 2022

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The development of immune-checkpoint inhibitors (ICIs) has heralded a new era in cancer treatment, enabling the possibility of long-term survival in patients with metastatic disease, and providing new therapeutic indications in earlier-stage settings. As such, characterizing the long-term implications of receiving ICIs has grown in importance. An abundance of evidence exists describing the acute clinical toxicities of these agents, although chronic effects have not been as well catalogued. Nonetheless, emerging evidence indicates that persistent toxicities might be more common than initially suggested. While generally low-grade, these chronic sequelae can affect the endocrine, rheumatological, pulmonary, neurological and other organ systems. Fatal toxicities also comprise a diverse set of clinical manifestations and can occur in 0.4–1.2% of patients. This risk is a particularly relevant consideration in light of the possibility of long-term survival. Finally, the effects of immune-checkpoint blockade on a diverse range of immune processes, including atherosclerosis, heart failure, neuroinflammation, obesity and hypertension, have not been characterized but remain an important area of research with potential relevance to cancer survivors. In this Review, we describe the current evidence for chronic immune toxicities and the long-term implications of these effects for patients receiving ICIs.

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“…A wide spectrum of rheumatologic irAEs has been reported. A multicenter cohort study reported that systematic polyarthritis was the most frequent rheumatologic irAE (15). Other rheumatologic irAEs include polymyalgia rheumatic-like syndromes, psoriatic arthritis, remitting seronegative symmetrical synovitis with pitting edema (RS3PE), tenosynovitis, vasculitis, myositis, scleroderma, and eosinophilic fasciitis (16)(17)(18).…”

Section: B a Cmentioning

confidence: 99%

Palmar Fasciitis and Polyarthritis Syndrome Associated with Lung Adenocarcinoma

et al. 2022

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Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic rheumatic disease with characteristic features. We herein report a 77-year-old man with lung adenocarcinoma and contralateral pulmonary metastasis receiving chemotherapy who presented with progressive symmetrical flexion contractures associated with palmar fascial thickening and arthritis of both hands and shoulders. He was diagnosed with PFPAS as paraneoplastic manifestations. Salazosulfapyridine was not effective, but 15 mg/day of oral prednisolone improved his symptoms. Physicians should consider PFPAS and rule out malignancy in patients with arthritis in the extremities and flexion contractures associated with palmar fascial thickening.

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Rheumatic immune-related adverse events associated with cancer immunotherapy: A nationwide multi-center cohort

Cited by 53 publications

References 30 publications

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

Immune Checkpoint Inhibitor-Associated Scleroderma-Like Syndrome: A Report of a Pembrolizumab-Induced “Eosinophilic Fasciitis-Like” Case and a Review of the Literature

Immune-checkpoint inhibitors: long-term implications of toxicity

Palmar Fasciitis and Polyarthritis Syndrome Associated with Lung Adenocarcinoma

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