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Researchers evaluate immune-related adverse events
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WASHINGTON — Researchers at the Cleveland Clinic have developed a system to evaluate and manage immune-related adverse events in patients with cancer treated with checkpoint inhibitors, according to an abstract presented at the American College of Rheumatology Annual Meeting.
Cassandra Calabrese, DO, rheumatologist at the Cleveland Clinic, and colleagues identified patients by oncologist and then triaged each patient with an advanced practitioner. Two rheumatologists saw all 12 patients. Researchers collected information on gender, date of birth, age at diagnosis of malignancy, type and stage of malignancy, prior treatment, checkpoint inhibitors, autoimmune history, nosology of immune-related adverse events (IRAEs), IRAE treatment, global response to treatment and prior autoimmune serologies.
Of the 12 patients, two had pre-existing rheumatoid arthritis and one had pre-existing psoriatic arthritis. In the nine patients without autoimmune disease, five patients had melanoma; two had lung adenocarcinoma; and two had renal cell. All patients had previous treatment with either surgery, chemotherapy, radiation or a combination of the three. Rheumatic IRAEs — which included four cases of inflammatory arthritis, two cases of polymyalgia, five cases of sicca and one case of myositis — led to cessation of checkpoint inhibitor therapy in all but one patient. Overall, most patients had more than one IRAE — which included hypophysitis, thyroiditis and rash — and the average time to IRAE was 52 days. Treatment — which consisted of glucocorticoids for all patients and additional therapy for three patients — led to significant improvement in five patients and moderate improvement in three. Of the three patients with pre-existing autoimmune disease, two had flares. The researchers concluded the epidemiology, natural history and pathophysiology of these complications remained undefined.
"We are still in the early stages of diagnosing and treating rheumatic irAEs secondary to checkpoint inhibitors and many questions remain unanswered," Calabrese told Healio Rheumatology. "Given the proliferation of checkpoint inhibitor therapy and the imminent arrival of immunotherapies targeting other immunologic checkpoints, rheumatologists must be alerted to these complications and collaborate with treating oncologists for accurate diagnosis and management." – by Will Offit
Reference:
Calabrese C, et al. Abstract #1339. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.
Disclosures: Calabrese reports no relevant financial disclosures. Please see the full abstract for a list of all other relevant financial disclosures.