Rheumatic immuno-related side effects from cancer immunotherapy

Golovach I.Yu., Yehudina Ye.D., Ter-Vartanіan S.Kh.

Summary. In recent decades, immunotherapy has revolutionized the treatment of cancer. However, the rapid growth in the use of the therapeutic agent fa­mily, known as immune checkpoint inhibitors (ICPIs), is associated with the emergence of a new group of clinical conditions — immune-related adverse events (irAEs), in which almost any organ system is involved in the pathological process. The aim of the study was to analyze and generalize exis­ting information about ICPIs and rheumatic ICPIs. Material and methods. It were held an overview of modern literature on the rheumatic immuno-related side effects from cancer immunotherapy. Five databases were used in the search: Medline, Medline Complete, Academic Search Complete, The Cochrane Library and PubMed in period of 2013–2019. Using key words: immune checkpoint inhibitors, immune-related adverse events, rheumatologic, arthritis, myositis, polymyalgia rheumatica, immunotherapy, immune-related toxicities, management. Results and discussion. Rheuma­tic irAEs are a fairly common complication of ICPIs therapy, they have their own distinctive features, including variable time of clinical onset and the ability to persist for an indefinite period, even after the cessation of ICPIs therapy. The role of rheumato­logists and their participation in the management of patients with rheumatic irAEs such as arthritis, myositis, dry syndrome, vasculitis, myocarditis, pulmonitis and others is leading. mechanisms of action of ICPIs and how they might cause rheumatic are described in this literature review. Also marked epidemiology, clinical characteristics, and management of patients with rheumatic irAEs according to leading guidelines. Conclusion. Rheumatologists should be aware of this new field of rheumatic diseases and become central partners in the interprofessional teams involved in the management of irAEs in the process of immunotherapy of patients with cancer.