Cancer Immunotherapy in Patients With Preexisting Rheumatic Disease: The Mayo Clinic Experience
Cancer Immunotherapy in Patients With Preexisting Rheumatic Disease: The Mayo Clinic Experience
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DOI：
10.1002/art.40397
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发表时间：
2018-03-01
影响因子：
13.3
通讯作者：
Thanarajasingam, Uma
中科院分区：
文献类型：
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作者：
Richter, Michael D.;Pinkston, Olga;Thanarajasingam, Uma
客观的。旨在确定接受免疫检查点抑制剂 (ICI) 治疗的既往风湿病患者发生风湿病发作的风险和不良反应。方法。我们对 2011 年至 2016 年间在明尼苏达州罗切斯特市梅奥诊所接受 ICI 治疗的所有患者进行了回顾性病历审查（相当于 700 名患者）。使用特定的诊断代码来识别那些患有先前存在的风湿病的人。结果。确定了 16 名患者（81% 为女性，中位年龄 68.5 岁）。最常见的风湿性疾病是类风湿性关节炎（n = 5）、风湿性多肌痛（n = 5）、干燥综合征（n = 2）和系统性红斑狼疮（n = 2）。在 ICI 开始时，7 名患者正在接受免疫抑制治疗或糖皮质激素治疗风湿病。原发性恶性肿瘤为黑色素瘤 (n = 10)、肺肿瘤 (n = 4) 或血液肿瘤 (n = 2)。在大多数情况下，只有在其他几种疗法失败后才提供 ICI。 6 名患者出现免疫相关不良反应 (IRAE)，所有患者均经糖皮质激素成功治疗并停止 ICI 治疗。患有和不患有IRAE的患者之间从癌症诊断到免疫治疗的时间、免疫治疗持续时间、年龄或性别没有显着差异。结论。据我们所知，这是接受现代癌症免疫治疗的最大的单中心风湿性疾病患者队列。这些患者中只有少数经历了先前存在的风湿病或任何其他 IRAE 的发作。
Objective. To determine the risk of rheumatic disease flare and adverse effects in patients with preexisting rheumatic disease who were receiving immune checkpoint inhibitor (ICI) therapy.Methods. A retrospective medical record review was performed to identify all patients who received ICI therapy at Mayo Clinic in Rochester, Minnesota between 2011 and 2016 (similar to 700 patients). Those with a preexisting rheumatic disease were identified using specific diagnostic codes.Results. Sixteen patients were identified (81% female, median age 68.5 years). The most common rheumatic diseases were rheumatoid arthritis (n = 5), polymyalgia rheumatica (n = 5), Sjogren's syndrome (n = 2), and systemic lupus erythematosus (n = 2). Seven patients were receiving immunosuppressive therapy or glucocorticoids for their rheumatic disease at the time of initiation of the ICI. The primary malignancies were melanoma (n = 10), pulmonary (n = 4), or hematologic (n = 2). In most cases, ICIs were offered only after failure of several other therapies. Immune-related adverse effects (IRAEs) occurred in 6 patients, and all were treated successfully with glucocorticoids and discontinuation of the ICI therapy. There were no significant differences in time from cancer diagnosis to immunotherapy, duration of immunotherapy, age, or sex between the patients with and those without IRAEs.Conclusion. To our knowledge, this represents the largest single-center cohort of patients with rheumatic diseases who were exposed to modern cancer immunotherapy. Only a minority of these patients experienced a flare of their preexisting rheumatic disease or any other IRAE.