Immune Checkpoint Inhibitor Related Rheumatological Complications: Cooperation between Rheumatologists and Oncologists

Renata Pacholczak-Madej (), Joanna Kosałka-Węgiel, Piotr Kuszmiersz, Jerzy W. Mituś, Mirosława Püsküllüoğlu, Aleksandra Grela-Wojewoda, Mariusz Korkosz and Stanisława Bazan-Socha
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Renata Pacholczak-Madej: Department of Clinical Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
Joanna Kosałka-Węgiel: Department of Rheumatology and Immunology, Jagiellonian University Medical Kraków, 30-688 Krakow, Poland
Piotr Kuszmiersz: Department of Rheumatology and Immunology, Jagiellonian University Medical Kraków, 30-688 Krakow, Poland
Jerzy W. Mituś: Department of Anatomy, Jagiellonian University Medical College, 33-332 Kraków, Poland
Mirosława Püsküllüoğlu: Department of Clinical Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
Aleksandra Grela-Wojewoda: Department of Clinical Oncology, The Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, 31-115 Kraków, Poland
Mariusz Korkosz: Department of Rheumatology and Immunology, Jagiellonian University Medical Kraków, 30-688 Krakow, Poland
Stanisława Bazan-Socha: Department of Internal Medicine, Jagiellonian University Medical College, 30-688 Kraków, Poland

IJERPH, 2023, vol. 20, issue 6, 1-20

Abstract: In cancer, immune checkpoint inhibitors (ICIs) improve patient survival but may lead to severe immune-related adverse events (irAEs). Rheumatic irAEs are a distinct entity that are much more common in a real-life than in clinical trial reports due to their unspecific symptoms and them being a rare cause of hospitalization. This review focuses on an interdisciplinary approach to the management of rheumatic irAEs, including cooperation between oncologists, rheumatologists, and immunologists. We discuss the immunological background of rheumatic irAEs, as well as their unique clinical characteristics, differentiation from other irAEs, and treatment strategies. Importantly, steroids are not the basis of therapy, and nonsteroidal anti-inflammatory drugs should be administered in the front line with other antirheumatic agents. We also address whether patients with pre-existing rheumatic autoimmune diseases can receive ICIs and how antirheumatic agents can interfere with ICIs. Interestingly, there is a preclinical rationale for combining ICIs with immunosuppressants, particularly tumor necrosis factor α and interleukin 6 inhibitors. Regardless of the data, the mainstay in managing irAEs is interdisciplinary cooperation between oncologists and other medical specialties.

Keywords: rheumatic adverse events; immune checkpoint inhibitors; immune-related adverse events; cancer immunotherapy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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