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Published on: April 22, 2019
Nivolumab Causing a Polymyalgia Rheumatica in a Patient With a Squamous Non-Small Cell Lung Cancer
Marjorie Bernier1, Cyril Guillaume, Nathalie Leon
1Departments of *Pharmacology †Pain and Palliative Care ‡Rheumatology ∥Pneumology, CHU of Caen §Department of General Medicine, Medical School, Normandie University, Caen, France.
Abstract:
The anti-programmed cell-death-1 antibody, nivolumab, has been recently approved for the treatment of advanced non-small cell lung cancer. Although, today, immune-related adverse effects such as dermatologic, digestive, hepatic, and endocrine toxicities are well-known with immune checkpoint inhibitors, rheumatic diseases are less well described. Herein, we report the case of a patient without a history of arthritis who developed polymyalgia rheumatica after 13 cycles of nivolumab used for the treatment of advanced non-small cell lung cancer. Laboratory evidence of inflammatory syndrome, articular echography, and clinical presentation with classical symptoms and also distal manifestations were suggestive of this chronic inflammatory disorder. Because of a relevant pain, clinicians were forced to suspend immunotherapy. Nevertheless, due to glucocorticoid therapy, the patient's symptoms have decreased progressively. Moreover, nivolumab was reintroduced 8 weeks later, whereas prednisone (10 mg) was continued, without any recurrence symptoms. To conclude, our case suggests that polymyalgia rheumatica might be a very disabling anti-programmed cell-death-1 immune-related adverse effect.
Insights
Polymyalgia rheumatica is a rare but disabling side effect of nivolumab, an anti-programmed cell-death-1 antibody used for advanced non-small cell lung cancer. Early diagnosis and treatment with glucocorticoids can manage symptoms and allow continued immunotherapy.
Area of Science:
- Oncology
- Immunology
- Rheumatology
Background:
- Immune checkpoint inhibitors like nivolumab are approved for advanced non-small cell lung cancer.
- While immune-related adverse effects (irAEs) are known, rheumatic diseases are less commonly reported.
- Nivolumab targets the programmed cell-death-1 (PD-1) pathway.
Purpose of the Study:
- To report a case of polymyalgia rheumatica (PMR) developing after nivolumab treatment.
- To highlight PMR as a potential irAE of PD-1 inhibitors.
- To discuss management strategies for irAEs in patients receiving nivolumab.
Main Methods:
- Case report of a patient with advanced non-small cell lung cancer treated with nivolumab.
- Clinical presentation, laboratory findings (inflammatory syndrome), and articular echography were used for diagnosis.
- Treatment involved temporary suspension of nivolumab, glucocorticoid therapy, and subsequent reintroduction of nivolumab.
Main Results:
- The patient developed polymyalgia rheumatica after 13 cycles of nivolumab.
- Symptoms included classical PMR features and distal manifestations, alongside laboratory evidence of inflammation.
- Glucocorticoid therapy led to symptom improvement, allowing nivolumab reintroduction without recurrence.
Conclusions:
- Polymyalgia rheumatica can be a disabling immune-related adverse effect of anti-programmed cell-death-1 therapy.
- This case underscores the importance of recognizing and managing rheumatic irAEs.
- Effective management with glucocorticoids may permit continued immunotherapy in select patients.
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