Myositis as an adverse event of immune checkpoint blockade for cancer therapy
Section snippets
Methods
Institutional databases were used to identify cancer patients aged at least 18 years, who had received treatment with ICI (either anti-PD-1 or anti-PD-L1 monotherapy, or combination therapy with anti-PD-1/CTLA-4) at any time between January 2004 and September 2016, to allow for sufficient follow-up. We identified 3016 patients from pharmacy records. Claims data were extracted for all the patients 6 months prior to the first infusion of to the last follow-up or death. International
Results
Six patients with de novo myositis were included (Table). Mean age was 64.3 years [standard deviation (SD) = 11.8 years], and five patients were male. All ICI that were approved during study period (ipilimumab, nivolumab, pembrolizumab, and atezolizumab were associated with at least one case of myositis. Half of the patients with de novo myositis had received combination therapy with ipilimumab and nivolumab.
Discussion
Immune checkpoint inhibitors have shown great promise in the treatment of various cancers, but their use can be hampered by the occurrence of inflammatory and irAE that can be severe. A plethora of irAE have been reported in the literature, which can affect nearly any organ or system, presenting management challenges [14], [15], [39]. Rheumatic irAE have been infrequently documented in clinical trials with a majority of the data coming from case reports and series [22], [40], [41].
Our series
Contribution
Dr. Suarez-Almazor conceived and supervised the study. Dr. Shah designed and carried out the study, extracted and analyzed the data and prepared the first draft of the manuscript. Dr. Tayar reviewed the data for accuracy and consistency and helped analyze the data. Dr. Abdel-Wahab assisted in acquiring the data and carrying out the ground work necessary for implementation of the study. All authors contributed to the composition and revision of the manuscript. All authors read and approved the
Declarations of interest
Dr. Suarez-Almazor reports personal fees from Pfizer, grants from Pfizer, personal fees from Elli Lilly, personal fees from Endo Pharmaceuticals, personal fees from Bristol Myers Squibb, personal fees from Genentech, personal fees from Ardea Pharmaceuticals, outside the submitted work.
Acknowledgments
We thank Erica A. Goodoff of the department of scientific publications at The University of Texas MD Anderson Cancer Center for copyediting the manuscript.
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