Kostine M, et al. - Cancer patients receiving immune checkpoint inhibitors (ICIs) were investigated for the prevalence and type of rheumatic immune-related adverse events (irAEs) associated with these pharmacological agents, as well as correlation of rheumatic irAEs with tumour response. Researchers observed that all patients responded either to low-to-moderate doses of prednisone or symptomatic therapies and did not require ICI discontinuation. Experience with rheumatic irAEs was found to be associated with a significantly higher tumor response.

Methods

• Including all cancer patients receiving ICIs, a single-centre prospective observational study was performed.
• Assessment of the occurrence of irAEs and tumour response was done on a regular basis.
• For clinical evaluation and management of patients who experienced musculoskeletal symptoms, referral to the department of rheumatology was made.

Results

• Findings demonstrated that, from September 2015 to May 2017, 524 patients received ICIs and 35 were referred to the department of rheumatology (6.6%).
• Researchers found that all but one of the rheumatic irAEs occurred with anti-programmed cell death protein 1(PD-1)/PD-1 ligand 1(PD-L1) antibodies, with a median exposure time of 70 days.
• Inflammatory arthritis (3.8%) mimicking either rheumatoid arthritis (n=7), polymyalgia rheumatica (n=11) or psoriatic arthritis (n=2) and (2) non-inflammatory musculoskeletal conditions (2.8%; n=15) were documented as the 2 distinct clinical presentations.
• Data showed that 1 patient with rheumatoid arthritis was anti-cyclic citrullinated peptide (anti-CCP) positive.
• Need for glucocorticoids was reported in 19 patients, and methotrexate was started in 2 patients.
• Non-steroidal anti-inflammatory drugs, analgesics and/or physiotherapy were the management options for non-inflammatory disorders.
• In all but 1 patient, ICI treatment was pursued.
• A higher tumour response rate was observed in patients with vs without rheumatic irAEs (85.7% vs 35.3%; P<0.0001).