Highlights
- •Management of anti-PD1 related rheumatic adverse events are less well described compared with other organ specific irAEs.
- •The chronic nature of rheumatic irAE can impact the quality of life and usually requires protracted immunomodulatory agents for management.
- •Patients who sustain a rheumatic irAE secondary to anti-PD1 appear to exhibit higher objective response rates than anticipated.
Abstract
Importance
Rheumatic immune-related adverse events (irAEs) occur in approximately 10–20% of anti–programmed
death 1 (anti-PD1)–treated cancer patients. There are limited data on the natural
history, optimal treatment and long-term oncological outcomes of patients with rheumatic
irAEs.
Objective
The objective of the study was to describe the spectrum and natural history of rheumatic
irAEs and the potential impact of rheumatic irAEs and immunomodulators on anti-PD1
tumour efficacy.
Methods
Cancer patients with pre-existing rheumatic disease before anti-PD1 therapy or de novo rheumatic irAEs on anti-PD1 therapy were retrospectively reviewed across three sites.
Patient demographics, treatment history, anti-PD1 irAEs, and anti-PD1 responses were
evaluated. Relationships between the development or pre-existence of rheumatic irAE,
use of immunomodulatory agents and outcomes were evaluated.
Results
This multicenter case series describes 36 cancer patients who had rheumatic disease
before anti-PD1 therapy (n = 12) or developed de novo rheumatic irAEs (n = 24). Thirty-four of the 36 patients sustained rheumatic irAEs
(median time to rheumatic irAE: 14.5 weeks), including 24 de novo (18 inflammatory arthritis, three myositis, two polymyalgia rheumatica, one fasciitis) and
10 flares in 12 patients with pre-existing rheumatic disease. Corticosteroids were
used in 30 of 36 patients (median duration: 10 months), and disease-modifying antirheumatic
drugs were used in 14 of 36 patients (median duration: 5.5 months). The objective
response rate to anti-PD1 therapy was 69% (n = 25/36) overall and 81% (n = 21/26)
in the melanoma subgroup.
Conclusions
Rheumatic irAEs are often chronic and require prolonged immunomodulatory therapy.
Prospective studies are required to define optimal management of rheumatic irAEs that
maintain long-term anticancer outcomes.
Keywords
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Article info
Publication history
Published online: November 13, 2018
Accepted:
September 25,
2018
Received in revised form:
August 22,
2018
Received:
June 7,
2018
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Ltd. All rights reserved.
