Rheumatic Diseases and Syndromes Induced by Cancer Immunotherapy

Book excerpt: With the increasing use of immune checkpoint inhibitors (ICI) across various cancers, the trends for indication at earlier stages, and the use of combination immunotherapy, the frequency of ICI-induced immune-related adverse events (irAE) is expected to grow substantially. Management of these irAE is challenging as it requires not only consideration of the toxicity but also risk-benefit ratios with respect to the primary cancer. Several rheumatic irAE have been reported with ICI therapy including arthritis, myositis, polymyalgia-like syndromes, sicca/Sjogren-like manifestations, and several other less common systemic autoimmune features commonly associated with connective tissue disease. This handbook provides clinicians with a comprehensive overview of the management of rheumatic irAE that develop from cancer immunotherapy. It focuses on the irAE seen with ICI, the most frequently used agents in treating cancer. It provides an overview of cancer immunology, immunotoxicity, and immunotherapies such as ICI, cytokine-based therapy, and CART. It examines the epidemiology, clinical manifestations, diagnosis, differential diagnosis, and treatment of a variety of rheumatic immune-related adverse events arising from these therapies. Chapters also cover cancer immunotherapy in patients with preexisting rheumatic diseases such as inflammatory arthritis and other connective tissue disorders. The book helps clinicians to distinguish the current types of cancer immunotherapy and general toxicity patterns, recognize and diagnose rheumatic clinical syndromes, understand the pathogenesis of irAE, and consider risk–benefit ratios when managing patients with rheumatic irAE. Rheumatic Diseases and Syndromes Induced by Cancer Immunotherapy is an essential resource for physicians and related professionals, residents, fellows, graduate students and nurses alike in rheumatology, clinical immunology, oncology, and internal medicine.