Background/Purpose: Over the years there has been a huge effort to change the traditional way to treat cancer, that was previously based on chemotherapy and/or radiotherapy. Enhancing the immune system with immunotherapy, instead of suppressing it, has achieved impressive results in some tumors, mainly metastatic melanoma, and nowadays several other tumors are been treated with it. Along with better results regarding tumor control, several immune-mediated adverse events have emerged

Methods: We included retrospectively all patients diagnosed with cancer that received immunotherapy (check point inhibitors) as part of their treatment between January 2014 and June 2018. Immunotherapy includes: monoclonal antibody to CTLA4 ipilimumab, IgG4 programmed death 1 (PD-1) inhibitor antibody nivolumab and pembrolizumab. There were no patients receiving IgG4 programmed death 1 ligand (PDL-1) inhibitor antibody atezolizumab, avelumab or durvalumab. We reported all immune-mediated adverse event (IMAE), time to first IMAE, treatment received, response to treatment, discontinuation of immunotherapy and deaths.

Results: Results: A total of 27 patients, (54.5% males) were included. Type of tumor, name of check point inhibitor received, type of IMAE, time to first IMAE, treatment and response are summarized in table 1. We observed a total of 11 (40.7%, CI 95% 23.2-60.9) IMAE. Incidence density rate was 120.9 (100 person-year). The most frequents were hematologic and dermatologic adverse events. Most of the IMAE were mild to moderate, 27.3% required treatment, with 66% of response. Among the rheumatologic related IMAE, there were only arthritis and Sicca syndrome, the last one been the most frequent and generally mild, with no need for treatment. 2 patients presented with arthritis, one of them required methotrexate because of persistent arthritis. No specific autoantibodies were found. Only 1 out of 5 patients with rheumatic IMAE was sent to a rheumatologist for treatment, all others were managed by oncologists. No patients were evaluated by a rheumatologist before started immunotherapy.

Conclusion: immune-mediated adverse events related to check point’s inhibitors are a new entity and oncologist and rheumatologist must be aware of them. Rheumatic IMAE had a frequency of 27.3%, with Sicca syndrome and seronegative arthritis as the only manifestations in our cohort.

TABLE 1. General Characteristics

TABLE 2. Rheumatologic IMAE

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/immune-related-adverse-events-in-cancer-immunotherapy-how-often-do-we-see-them/