Cancer treatment with the immune checkpoint inhibitors nivolumab and ipilimumab may cause patients to develop inflammatory arthritis or sicca syndrome, claims a study conducted by a group of researchers at Johns Hopkins University in Baltimore, MD.
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Immunotherapeutic agents such as nivolumab and ipilimumab have demonstrated significant survival improvements in a number of different cancer types, but they have also been known to cause immune-related adverse events, which are still not very well understood.
In a study published in Annals of the Rheumatic Diseases, researchers led by Laura C Cappelli, MD, Johns Hopkins University, reported on the occurrence of inflammatory arthritis and sicca syndrome in patients with various cancer types after treatment with nivolumab or ipilimumab.
A total of 13 patients were analyzed for the study, with 8 receiving treatment with both nivolumab and ipilimumab and the reminder receiving monotherapy with one or the other. Six patients were treated for melanoma, 5 for non-small cell lung cancer, 1 for renal cell carcinoma, and 1 for small cell lung cancer.
Overall, 9 of the 13 patients developed inflammatory arthritis that involved both large and small joints. In 6 patients, the arthritis also evolved to a rheumatoid arthritis-like pattern of synovitis of the proximal interphalangeal and meta carpophalangeal joints and writs.
The remaining 4 patients reported sicca symptoms with evidence of salivary gland dysfunction and swelling of the parotid glands, which in two patients were accompanied by pneumonitis, interstitial nephritis, or colitis. In 3 patients who were found to be positive for antinuclear antibodies, prednisone was used.
Researchers concluded that more research will be needed to understand the mechanisms, determine risk factors, and develop management algorithms for rheumatic immune-related adverse events associated with immune checkpoint inhibitors.
