The European League Against Rheumatism (EULAR) has published recommendations around rheumatic immune-related adverse events (irAEs) caused by cancer treatment with checkpoint inhibitors (ICI).
EULAR recommends that the following 10 points should be considered:
- Awareness of the wide spectrum of clinical presentations of rheumatic immune-related adverse events.
- Encourage and facilitate liaison between rheumatologists and oncologists.
- Metastases, paraneoplastic syndromes or unrelated rheumatic diseases might look like irAEs.
- Steroids (local/systemic) should be considered for irAEs (tapered to lowest effective dose).
- Conventional synthetic disease-modifying antirheumatic drugs (csDMARD) should be considered when the response to glucocorticoids is insufficient or for glucocorticoid-sparing.
- Biological DMARD (bDMARD) should be considered for severe rheumatic and systemic irAEs or insufficient response to csDMARDs. TNF or IL-6 inhibitors are preferred for inflammatory arthritis.
- Hold or continue immunotherapy based on severity, required immunosuppressive regimen, tumour response and duration, and future oncology plan, in consultation with the patient.
- Myositis can be a severe condition; immunotherapy withdrawal should be discussed. For life-threatening symptoms, high-dose glucocorticoids plus other treatments should be used instead.
- Cancer immunotherapy can be used in patients with pre-existing autoimmune rheumatic and/or systemic disease. Immunosuppressive regimen should be at the lowest dose.
- Autoantibody testing is not indicated for all patients before starting cancer treatment.