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Successful treatment of arthritis induced by checkpoint inhibitors with tocilizumab: a case series
  1. Sang Taek Kim1,
  2. Jean Tayar1,
  3. Van Anh Trinh2,
  4. Maria Suarez-Almazor1,
  5. Salvador Garcia3,
  6. Patrick Hwu2,
  7. Daniel Hartman Johnson4,
  8. Marc Uemura4,
  9. Adi Diab2
  1. 1Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Section of Immunology, Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  4. 4Hematology and Medical Oncology Fellowship, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Adi Diab, Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center FC3004, 1515 Holcombe Blvd Houston, Texas; adiab{at}mdanderson.org

Abstract

Background Immune checkpoint inhibitors (ICIs) have significantly improved outcomes for patients with numerous cancers. However, these therapies are associated with immune-related adverse events (irAEs), which are inflammatory side effects potentially affecting any organ. Cases of ICI-induced inflammatory arthritis have also been reported. In general, mild irAEs are treated with corticosteroids, while tumour necrosis factor-α (TNFα) inhibitors are reserved for refractory cases. However, prolonged use of TNFα inhibitor (TNFαi) can induce widespread, significant immunosuppression, which can negatively impact the antitumour efficacy of ICI therapy. Therefore, in clinical scenarios where patients develop severe immunotherapy-induced irAEs, an unmet need exists for alternative therapeutic strategies that are effective and without immune dampening effects.

Case reports The anti-interleukin (IL)−6 receptor antibody, tocilizumab, is a biological agent Food and Drug Administration approved for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis. Here, we report on three patients who developed severe polyarthritis while receiving ICI therapy and were treated with tocilizumab. All three patients demonstrated significant clinical improvement; one patient maintained a durable antitumour response derived from checkpoint inhibition.

Conclusions These three cases suggest that anti-IL-6 receptor antibody may be an effective alternative to corticosteroids or TNFαi for the treatment of arthritis irAEs.

  • arthritis
  • inflammation
  • TNF-alpha
  • DMARDs(biologic)

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors STK, JT, MS-A, MU, DHJ and AD wrote/edited the manuscript. All authors were involved in management of each cases. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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