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Rheumatic Manifestations of Cancer Immunotherapies

  • Antoni Chan, MD, PhD
10 November 2019

One area I am very interested to learn more about at #ACR19 are the rheumatic manifestations of cancer immunotherapies. In the last 5 years, there has been an expansion of the use of immune checkpoint inhibitor (CPIs) therapy in cancer. The number of patients treated with CPIs is predicted to further increase in coming years. With this in mind, there is a need to understand the spectrum and frequency of these drugs. CPIs regulate T cell activation and effector function and are highly effective in treating a wide range of cancer. These drugs target two broad signaling pathways that begin with interaction of either cytotoxic T lymphocyte-associated antigen 4 (CTLA4) with CD28 eg. Ipilimumab, or programmed cell death protein 1 (PD-1) with programmed cell death ligand 1 (PD-L1) eg. Pembrolizumab and Nivolumab. 

There are differences in the timing and characteristics of toxicity with single-agent and combination immune CPIs. The patterns and kinetics of immune-related adverse events (irAEs) with the use of checkpoint inhibitors are similar to, but differ from traditional autoimmune diseases. There is a highly variable time of clinical onset and capacity to persist. Nearly every major category of rheumatic disease, including inflammatory arthritis, myositis, vasculitis and scleroderma, is mirrored by a category of irAEs resulting from CPI. The use of biomarkers for assessing the severity of immune-related adverse events of cancer immunotherapies may be of clinical use.  

Treatment of irAEs often requires immunosuppression with glucocorticoids, which are sometimes administered with conventional synthetic or biologic disease-modifying drugs. Conversely, there are also commonly used drugs in rheumatology eg. proton pump inhibitors and ACE inhibitors that may alter the anti-tumoral response to immune CPIs. I hope to understand more about the treatment approach of immune related adverse events related to immune checkpoint inhibitor therapy. The sessions at #ACR19 that will cover this topic are listed here.  I will be sharing more on this area from #ACR19. 

Location: Thomas Murphy Ballroom 1 & 2
Date: Sunday, Nov 10 8:30 AM
3S014 Adverse Outcomes of Cancer Immunotherapies
Location: B308

Date: Monday, Nov 11 1:00 PM
4M070 Study Group: Cancer Immunotherapy & Rheumatic Disease: Classification & Guidelines
Location: B302-B303
Date: Monday, Nov 11 2:30 PM
4M091 Miscellaneous Rheumatic & Inflammatory Disease II: Checkpoint Inhibitors-Induced & Other Rheumatic Conditions