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Addressing immune-related adverse events of cancer immunotherapy: how prepared are rheumatologists?
  1. Marie Kostine1,
  2. Laura C Cappelli2,
  3. Cassandra Calabrese3,
  4. Leonard H Calabrese3,
  5. Clifton O Bingham III2,
  6. Christophe Richez1,
  7. Jacques-Eric Gottenberg4,
  8. Olivier Lambotte5
  1. 1 Rheumatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
  2. 2 Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3 Rheumatology/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4 Rheumatology, Hopitaux Universitaires de Strasbourg, Strasbourg, France
  5. 5 Internal Medicine and Clinical Immunology, Hopital Bicetre, Le Kremlin-Bicetre, France
  1. Correspondence to Dr Marie Kostine, Rheumatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux 33000, France; marie.kostine{at}

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Cancer immunotherapy blocking immune checkpoints represents a major advance in oncology. Immune checkpoint inhibitors (ICI) targeting cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death 1 (PD-1) or its ligand PD-L1 have become standard of care in many advanced-stage cancers. Yet an important proportion of patients experience inflammatory or autoimmune side effects, also known as immune-related adverse events (irAEs), as a consequence of dysregulated immunity. irAEs can affect almost any organ system.1 Notably, an expanding range of manifestations mimicking our classical rheumatic diseases have been described.2 3 Rheumatic irAEs, including inflammatory arthritis, pseudomyalgia rheumatica, sicca syndrome, myositis and vasculitis, are increasingly reported. Since there has been increasing emphasis on this emerging field within the last 3 years, we aimed to evaluate the knowledge of rheumatologists, as well as other specialists, regarding ICI and irAEs through an online survey.

Survey questions addressed the demographics (gender, age, practice setting and duration of medical practice), domains of awareness, clinical experience and interest in irAE-specific medical education. The survey was first distributed in the USA (2016) to healthcare provider cohorts at Johns Hopkins University (JHU) and Cleveland Clinic (CC), then in France (2018) to rheumatologists and other specialists via …

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  • Handling editor Josef S Smolen

  • Collaborators Société Française de Rhumatologie (SFR), Club Rhumatismes et Inflammations (CRI), Société Nationale Française de Médecine Interne (SNFMI), Groupe d’Etude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID) and Société Française d’Endocrinologie (SFE).

  • Contributors LCC, CC, LHC and COB planned and conducted the study in the USA. OL, J-EG, CR and MK conducted the study in France. MK, LCC and CC drafted the manuscript, and all the authors critically reviewed and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MK received speaking fees from BMS. LCC received research grant from BMS and reported consulting for Regeneron. COB has served as consultant for BMS, Regeneron and Genentech/Roche, and received grant support from BMS. CR received speaking fees from BMS, AstraZeneca and Genentech/Roche. J-EG received honoraries from BMS and Pfizer and research grant from BMS. OL received paid expert testimony and consultancy fees from BMS France, MSD and AstraZeneca, consultancy fees from Genzyme, and expert testimony for Janssen. CC and LHC declared no conflict of interest for this work.

  • Patient consent for publication Not required.

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