Abstract
Immune checkpoint inhibitors (ICIs), which can enhance antitumor immunity and inhibit cancer growth, have revolutionized the treatment of multiple cancers and dramatically decreased mortality. However, treatment with ICIs is directly associated with immune-related adverse events (irAEs) because of inflammation in off-target organs and autoimmunity resulting from non-specific immune activation. These irAEs can cause rheumatic diseases and manifestations such as inflammatory arthritis, polymyalgia rheumatica, myositis, vasculitis, Sicca and Sjogen's syndrome, and systemic lupus erythematosus. Early diagnosis and treatment of these adverse events will improve outcomes and quality of life for cancer patients. The treatment of rheumatic diseases induced by ICIs requires multidisciplinary cooperation among physicians. Furthermore, the underlying mechanisms are not fully understood and it is difficult to predict and evaluate these side effects precisely. In this review, we summarize available studies and findings about rheumatic irAEs, focusing mainly on the clinical manifestations, epidemiology, possible mechanisms, and guiding principles for treating these irAEs.
Highlights
Cancer, one of the most serious diseases affecting human health, has become the second leading cause of death worldwide—accounting for nearly a quarter of deaths—and the number of patients and deaths is growing rapidly every year [1]
IrAEs can affect multiple organs; this varies from patient to patient, and different patients present with diverse clinical manifestations ranging from mild, to moderate, severe, and generally requiring hospitalization, life-threatening, and death caused by adverse drug reactions according to the Common Terminology Criteria for Adverse Events (CTCAE) system [5, 6]
We summarize the latest studies and findings about the clinical manifestations, unresolved questions, and underlying immune mechanisms, and propose approaches to the management of rheumatic diseases resulting from the use of Immune checkpoint inhibitors (ICIs)
Summary
One of the most serious diseases affecting human health, has become the second leading cause of death worldwide—accounting for nearly a quarter of deaths—and the number of patients and deaths is growing rapidly every year [1]. IrAEs are similar to various rheumatic diseases, including Sicca and Sjogren’s syndrome (SS), myositis, arthritis, vasculitis, polymyalgia rheumatica (PMR), and systemic lupus erythematosus (SLE) [7]. Some of these inflammatory symptoms may be overlooked and confused with the related symptoms during the cancer treatment by physicians. PMR syndrome is characterized by acute predominant joint pain and morning stiffness (shoulders, neck, hips, thighs) [24, 36,37,38,39] It commonly occurs about 3 months after starting ICI treatment and accompanied by other rheumatic irAEs [40]. CK, EMG, MRI, muscle biopsy troponin, transaminases, ESR, CRP, anti-striated Muscle, acetylcholine receptor, and myositis Antibody panel Echocardiogram and EKG to screen for concomitant myocarditis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
