Sicca/Sjogren's syndrome triggered by PD-1/PD-L1 checkpoint inhibitors. Data from the International ImmunoCancer Registry (ICIR)

Ramos-Casals, M.; Maria, A.; Suarez-Almazor, M. E.; Lambotte, O.; Fisher, B. A.; Hernandez-Molina, G.; Guilpain, P.; Pundole, X.; Flores-Chavez, A.; Baldini, C.; Bingham, C. O.; Brito-Zeron, P.; Gottenberg, J. -E.; Kostine, M.; Radstake, T. R. D.; Schaeverbeke, T.; Schulze-Koops, H.; Calabrese, L.; Khamashta, M. A.; Mariette, X.; Kostov, Belchin; Calabrese, Cassandra; Retamozo, Soledad; Ma Aguilar, Eva; Richter, Michael David; Lidar, Merav; Fisher, Ben; Michot, Jean Marie; Liew, David; Heiberg, Marte Schrumpf; Danda, Debashish; Olsson, Peter; Suzuki, Yasunori; Citera, Gustavo; Kawano, Mitsuhiro; Kilickap, Saadettin; Arrieta, Oscar; Moca Trevisani, Virginia Fernandes; Praprotnik, Sonja; Horvath, Ildiko Fanny und Azuma, Naoto (2019): Sicca/Sjogren's syndrome triggered by PD-1/PD-L1 checkpoint inhibitors. Data from the International ImmunoCancer Registry (ICIR). In: Clinical and Experimental Rheumatology, Bd. 37, Nr. 3: S114-S122

Abstract

Objectives: To analyse the worldwide occurrence of sicca/Sjogren's (SS) syndrome associated with the use of immune checkpoint inhibitors (ICI) in patients with cancer. Methods: The ImmunoCancer International Registry (ICIR) is a Big Data-Sharing multidisciplinary network composed by 40 specialists in Rheumatology, Internal Medicine, Immunology and Oncology from 18 countries focused on the clinical and basic research of the immune-related adverse events (irAEs) related to cancer immunotherapies. For this study, patients who were investigated for a clinical suspicion of SS after being exposed to ICI were included. Results: We identified 26 patients (11 women and 15 men, with a mean age at diagnosis of 63.57 years). Underlying cancer included lung (n=12), renal (n=7), melanoma (n=4), and other (n=3) neoplasia. Cancer immunotherapies consisted of monotherapy (77%) and combined regimens (23%). In those patients receiving monotherapy, all patients were treated with PD-1/PD-L1 inhibitors (nivolumab in 9, pembrolizumab in 7 and durvalumab in 4);no cases associated with CTLA-4 inhibitors were identified. The main SS-related features consisted of dry mouth in 25 (96%) patients, dry eye in 17 (65%), abnormal ocular tests in 10/16 (62%) and abnormal oral diagnostic tests in 12/14 (86%) patients. Minor salivary gland biopsy was carried out in 15 patients: histopathological findings consisted of mild chronic sialadenitis in 8 (53%) patients and focal lymphocytic sialadenitis in the remaining 7 (47%);a focus score was measured in 5 of the 6 patients (mean of 1.8, range 1-4). Immunological markers included positive ANA in 13/25 (52%), anti-Ro/SS-A in 5/25 (20%), RF in 2/22 (9%), anti-La/SS-B in 2/25 (8%), low C3/C4 levels in 1/17 (6%) and positive cryoglobulins in 1/10 (10%). Classification criteria for SS were fulfilled by 10 (62%) out of 16 patients in whom the two key classificatory features were carried out. Among the 26 patients, there were only 3 (11%) who presented exclusively with sicca syndrome without organ-specific autoimmune manifestations. Therapeutic management included measures directed to treat sicca symptoms and therapies against autoimmune-mediated manifestations (glucocorticoids in 42%, second/third-line therapies in 31%);therapeutic response for systemic features was observed in 8/11 (73%). No patient died due to autoimmune involvement. Conclusions: Patients with Sjogren's syndrome triggered by ICI display a very specific profile different from that reported in idiopathic primary SS, including more frequent occurrence in men, a higher mean age, a predominant immunonegative serological profile, and a notable development of organ-specific autoimmune involvement in spite of the poor immunological profile. The close association found between sicca/Sjogren's syndrome and primarily PD-1 blockade requires further specific investigation. \

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0392-856X
• Sprache: Englisch