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Immune Checkpoint Inhibitor Associated Rheumatic Adverse Events: a Review of Their Presentations and Treatments

  • Carrie YeEmail author
  • Shahin Jamal
  • Marie Hudson
  • Aurore Fifi-Mah
  • Janet Roberts
Cancer and Inflammatory Arthritis (J Pope, Section Editor)
  • 18 Downloads
Part of the following topical collections:
  1. Topical Collection on Cancer and Inflammatory Arthritis

Abstract

Purpose of review

Immune checkpoint inhibitors (ICI) are now the cornerstone of treatment for metastatic melanoma and are increasingly used in many other advanced stage malignancies. Immune checkpoint inhibitors enhance the endogenous anti-tumor response by inhibiting key regulatory pathways, facilitating robust anti-tumor responses, but often inducing a host of autoimmune toxicities which span multiple organ systems and are referred to as immune-related adverse events (irAEs). Here, we answer common questions rheumatologists may encounter in the management of these patients, including those with pre-existing autoimmune and rheumatic disease.

Recent Findings

Rheumatic irAEs including inflammatory arthritis, myositis, vasculitis, and sarcoidosis represent unique challenges for oncologists and rheumatologists in both the recognition and management of these entities. There are increasing numbers of case series and retrospective cohort studies describing the clinical and serological presentations and outcomes of patients who have developed rheumatic irAE. While in many ways similar to well established rheumatic diseases, the rheumatic irAE also appear to be different clinically, serologically, and in their response to treatment. There is also a growing body of literature on the use of ICI in patients with pre-existing autoimmune disease. While previously excluded from ICI clinical trials, the current literature would suggest that having a pre-existing autoimmune disease should not be an absolute contraindication to ICI therapy.

Summary

Prompt diagnosis and treatment initiation is essential to improve patient outcomes and optimize cancer therapy. Guidelines have been developed to guide treating rheumatologists and oncologists; however, important questions remain unanswered with the majority of guidelines based on expert consensus.

Keywords

Immune checkpoint inhibitors Rheumatic irAE Inflammatory arthritis Myositis Vasculitis Sarcoidosis 

Notes

Compliance with Ethical Standards

Conflict of Interest

Carrie Ye declares that she has no conflict of interest. Shahin Jamal declares that she has no conflict of interest. Marie Hudson declares that she has no conflict of interest. Aurore Fifi-Mah declares that she has no conflict of interest. Janet Roberts declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Carrie Ye
    • 1
    Email author
  • Shahin Jamal
    • 2
  • Marie Hudson
    • 3
  • Aurore Fifi-Mah
    • 4
  • Janet Roberts
    • 5
  1. 1.Division of Rheumatology, Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Division of Rheumatology, Vancouver General Hospital, Department of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.Division of Rheumatology, Jewish General Hospital and Lady Davis Institute; Department of MedicineMcGill UniversityMontréalCanada
  4. 4.Division of Rheumatology, Department of MedicineUniversity of CalgaryCalgaryCanada
  5. 5.Division of Rheumatology, Department of MedicineDalhousie UniversityHalifaxCanada

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