Abstract 350P
Background
Immune checkpoint inhibitors (ICI) have demonstrated improvement in overall survival across a range of tumor types. However, ICI therapy is associated with severe immune related adverse events (irAEs) including inflammatory arthritis. Here, we report our experience for rheumatological irAEs in patients with and without pre-existing auto-immune disease (AID).
Methods
Data was collected retrospectively for 15 patients identified as having rheumatological irAEs secondary to ICI therapy in our center between 2015-2019. We identified three patients with pre-existing AID.
Results
The mean age of the cohort was 66 years.The commonest tumour types were melanoma (73%) and NSCLC (27%). In the group without AID, (n=12), 7 patients developed inflammatory arthritis (IA). Two patients with PMR like syndrome depicted typical clinical phenotypes supported by raised inflammatory markers. The SICCA syndrome patient had biopsy proven lichenoid drug eruption and feature of xerostomia. One patient had synovial aspiration proved OA exacerbation treated with intra-articular corticosteroid injection, ceasing ICI. One patient developed grade 3 immune mediated myositis 12 days after commencing nivolumab. Muscle biopsy showed active inflammatory myopathy and lymphocytic vasculitis. Median time to any rheumatologic irAEs was 9.8 weeks. Treatment was withheld temporarily in patient and it was stopped permanently in 2 patients. All patients had high doses of glucocorticoids that led to significant, moderate and minimal improvement in 2, 8 and 2 patients, respectively. Additionally, 3 patients needed other disease modifying anti-rheumatoid drugs (DMARDs). In cohort with pre-existing AID (n=3), only patient with rheumatoid arthritis (RA), had flare of RA after 7 weeks of initiating ICI therapy. ICI therapy was withheld and had resolution of symptoms with steroids.
Conclusions
Rheumatic irAEs are serious and less understood adverse events secondary to ICI therapy requiring steroids and additional immunosuppressive therapy. Future studies should aim at defining the type of rheumatologic irAEs experienced in trials patients and response to steroids +/- DMARDs. A mutli-disciplinary approach is recommended.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Dr. Azim Khan.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
77P - Dual targeting oxidative phosphorylation and glycolysis in triple-negative breast cancers: En route to effective inhibition of tumour metabolism
Presenter: Alexander Scherbakov
Session: e-Poster Display Session
78P - Novel allogeneic cell immunotherapy for advanced cancers
Presenter: Ratnavelu Kananathan
Session: e-Poster Display Session
86P - The impact of sarcopenia on chemotherapy toxicity and survival rate among colorectal cancer patients who underwent chemotherapy: A systematic review and meta-analysis
Presenter: Timotius Hariyanto
Session: e-Poster Display Session
87P - Predictive risk factors and online nomograms for colon cancer with synchronous liver metastasis
Presenter: Yajuan Zhu
Session: e-Poster Display Session
88P - Research of radiomics based on indeterminate lung nodules predicting prognosis of LARC patients
Presenter: Zhang Zhiyuan
Session: e-Poster Display Session
89P - Biomarker analysis of regorafenib dose escalation study (RECC study): A phase II multicenter clinical trial in Japan
Presenter: Masanobu Enomoto
Session: e-Poster Display Session
90P - The role of miR-133a-3p/SP1/IGF1R axis in the progression of colorectal cancer
Presenter: Hui Li
Session: e-Poster Display Session
91P - Prognostic biomarker of clinical outcome in locally advanced rectal cancer in Chinese patients
Presenter: Sandy Ho
Session: e-Poster Display Session
92P - Development and validation of risk and prognostic nomograms for bone metastases in advanced colorectal cancer patients
Presenter: Nan Wang
Session: e-Poster Display Session
93P - Assessment of nutritional status of colorectal cancer patients in a tertiary government hospital
Presenter: Rogelio Velasco
Session: e-Poster Display Session