Background: Immune checkpoint inhibitors (ICIs) including monoclonal antibodies to PD-1 and CTLA-4 have revolutionised the treatment of metastatic melanoma and other malignancies. Rheumatic complications, otherwise known as rheumatic immune related adverse events (RirAE) have been documented in retrospective case reports and case series and include arthralgia, myalgia, inflammatory arthritis, myositis, PMR-like syndrome, connective tissue disease, sarcoidosis and vasculitis. The prevalence and incidence of RirAEs is not definitively established and estimates from clinical trials of anti-PD1 and anti-CTLA-4 therapies are broad ranging, with suspected under-reporting, as these events are of lesser severity. Nevertheless, a significant proportion of patients on ICIs have had to temporarily suspend or to stop treatment due to rheumatic complications. Hence, identification of risk factors to enable early detection of rheumatic complications and prompt assessment is vital, as this will facilitate early amelioration of symptoms and support continued treatment with ICIs.
Methods:
180 patients with stage 3 or 4 melanoma completed a questionnaire designed to capture rheumatic symptoms. The severity of symptoms was additionally quantified with standardised measures for rheumatic symptoms including the ‘‘Visual Analogue Scale (VAS)’ and ‘Health Assessment Questionnaire (HAQ)’. Patients were also asked whether they attributed their symptoms to their cancer treatment. Information regarding prior history of rheumatic disease including both mechanical and inflammatory disease, risk factors for the development of autoimmunity and symptoms, diagnosis and treatment of other immune related adverse events (irAEs) were also included.
Information pertaining to the patient’s melanoma stage, ICI treatment, response to treatment, irAEs and their management was gleaned from the clinical notes and research database. The patients were consented to complete a follow up questionnaire at 6 and 12 months and the follow up period is currently ongoing.
Results:
Results from analysis of the first 50 patients revealed that 8% of patients experienced new joint, muscle or axial pain, with worsening of pre-existing symptoms occurring in 14% of patients. 60% of patients experienced no change in pre-existing symptoms and 18% experienced improvement. Interestingly, 20% of patients attributed new or worsening symptoms to their treatment with immune checkpoint inhibitors and only 1 patient reported having considered ceasing treatment.
The results from the first 100 patients will be presented at this meeting.
Conclusions:
To be presented.