Studies provide insight into link
between cancer immunotherapy and
By Jennie Smith and Mitchel L. Zoler
VIDEO HIGHLIGHTS: Click here to watch a video interview with Dr. Leonard Calabrese of the
Cleveland Clinic, Cleveland, USA.
Rheumatologists all over the
world are beginning to find that
the new class of anticancer immune checkpoint inhibitor therapies have the potential to elicit
symptoms of rheumatoid arthritis
(RA) and other rheumatic diseases in patients with no previous
history of them, according to two
reports from the congress.
These immune checkpoint inhibitor (ICI) agents, which include
ipilimumab, nivolumab, and pem-brolizumab, target regulatory pathways in T cells to boost antitumour
immune responses, leading to
improved survival for many cancer
patients, but the induction of rheumatic disease can sometimes lead
to the suspension of the agents,
according to investigators.
Dr. Cassandra Calabrese, an
osteopathic physician at the Cleve-
land Clinic, Cleveland, USA, pre-
sented results from a retrospective
chart review of 19 patients referred
with symptoms of autoimmune
disease after treatment with this
class of drugs. Three patients had
a preexisting autoimmune disease
and were referred preemptively
prior to starting immunotherapy.
The remaining 16 patients had no
history of autoimmune disease
and developed symptoms a median of 16 weeks after starting treatment.
“This phenomenon was unknown to me and my group before
[February 2016], when we started
noting referrals of patients from
oncology,” Dr. Calabrese said.
“We were seeing symptoms of
everything from Sjögren’s syn-
drome to inflammatory arthritis
and myositis in patients being
treated with these drugs for their
cancer.” The same year, Dr. Cala-
brese and her team began coordi-
nating an ongoing study to assess
Dr. Calabrese said that the cohort
has shown so far that patients who
develop autoimmune disease after immune checkpoint inhibitors
“require much higher doses – of
steroids in particular – to treat their
symptoms,” and this can all too
often result in being taken out of a
clinical trial or having to stop cancer treatment.
Most of the patients in the cohort
were treated with steroids only,
while three patients received biologic agents, and four received
methotrexate or antimalarials.
Dr. Calabrese said that the serology results were available for
all the patients in the cohort and