[Autoimmune reactions to immune checkpoint inhibitors]

Area of Science:

• Oncology
• Immunology
• Rheumatology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, leading to approvals for various advanced cancers.
• ICI therapy can trigger autoimmune reactions affecting multiple organs, including the musculoskeletal system, skin, and endocrine glands.
• The expanding use of ICIs, including combination therapies, necessitates a deeper understanding of their associated immune-related adverse events (irAEs).

Purpose of the Study:

• To highlight the increasing importance of rheumatologists in recognizing and managing irAEs associated with cancer immunotherapy.
• To emphasize the need for rheumatologists to be aware of potential exacerbations of pre-existing autoimmune diseases due to ICIs.
• To underscore the imperative of diagnosing rheumatic manifestations as adverse events of cancer immunotherapies.

Main Methods:

• Review of current literature on immune checkpoint inhibitors and their associated adverse events.
• Analysis of organ systems commonly affected by irAEs, with a focus on rheumatic manifestations.
• Discussion of diagnostic considerations and treatment strategies for irAEs, including the role of rheumatologists.

Main Results:

• ICI therapy is associated with a range of irAEs, with the gastrointestinal tract, musculoskeletal system, skin, endocrine organs, liver, and lungs being frequently affected.
• Rheumatologists are crucial in identifying inflammatory arthritis and other rheumatic conditions linked to cancer immunotherapies.
• Management of irAEs involves assessing symptom severity, ruling out infections, and tailoring treatments, often involving steroids for severe reactions.

Conclusions:

• Rheumatologists' expertise is vital for managing irAEs, especially rheumatic manifestations, as ICI use becomes more widespread in cancer treatment.
• Early recognition and appropriate management of irAEs are essential for patients undergoing cancer immunotherapy.
• Treatment for irAEs, particularly rheumatic conditions, requires individualized approaches based on symptom severity and patient factors.