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Nivolumab-induced synovitis is characterized by florid T cell infiltration and rapid resolution with synovial biopsy-guided therapy
- Source :
- Journal for ImmunoTherapy of Cancer, Vol 8, Iss 1 (2020), Journal for Immunotherapy of Cancer
- Publication Year :
- 2020
- Publisher :
- BMJ Publishing Group, 2020.
-
Abstract
- BackgroundImmune checkpoint inhibitors (ICIs) are associated with rheumatic and musculoskeletal immune-related adverse events (irAEs) in 5%–20% of patients. Currently, patients refractory to corticosteroids and conventional disease-modifying antirheumatic drugs (cDMARD) are treated with biological DMARDs (bDMARDs) targeting tumor necrosis factor α (TNFα) and interleukin-6, although without a clear biological rationale. Synovial tissue (ST) biopsy presents a valuable opportunity to investigate irAE pathogenesis and appropriately stratify bDMARD use in refractory irAE patients.Case presentationWe provide the first report of comparative, parallel ST and synovial fluid (SF) analyses of severe, cDMARD-refractory, seronegative polyarthritis, classified as a grade 3 irAE occurring in response to nivolumab treatment for metastatic squamous cell lung cancer, in comparison with ST and SF from patients with untreated rheumatoid arthritis (RA). We investigated immunohistochemical labeling of ST cytokine expression as a biological rationale for selecting therapy. Flow cytometric analysis of lymphocytes from ST, SF and blood collected before and after synovial biopsy-guided therapy, in comparison with RA, were evaluated for insights into the immunopathogenesis of irAE. Immunolabeling of ST demonstrated an excess of TNFα cytokine expression. Subsequent treatment with infliximab resulted in resolution of inflammatory symptoms and a significant reduction in C reactive protein levels. Flow cytometric analysis of synovial infiltrates indicated absence of programmed cell death protein-1 (PD-1) receptor positivity despite cessation of nivolumab approximately 200 days prior to the analyzes.ConclusionsA deeper understanding of the immunopathogenetic basis of immune activation in irAEs is required in order to select therapy that is likely to be the most effective. This is the first report investigating parallel blood, ST and SF in ICI-induced severe rheumatic irAE. Use of a bDMARD directed by the dominant inflammatory cytokine achieved resolution of synovitis while maintaining cancer remission.
- Subjects :
- 0301 basic medicine
Male
Cancer Research
medicine.medical_specialty
Lung Neoplasms
medicine.medical_treatment
T-Lymphocytes
Immunology
rheumatology
Case Report
03 medical and health sciences
0302 clinical medicine
Antineoplastic Agents, Immunological
Gastrointestinal Agents
Internal medicine
Synovitis
Biopsy
medicine
Immunology and Allergy
Synovial fluid
Humans
RC254-282
030203 arthritis & rheumatology
Pharmacology
medicine.diagnostic_test
business.industry
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Middle Aged
medicine.disease
Prognosis
Rheumatology
Infliximab
030104 developmental biology
Cytokine
Nivolumab
Oncology
Rheumatoid arthritis
Carcinoma, Squamous Cell
Molecular Medicine
business
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 20511426
- Volume :
- 8
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal for ImmunoTherapy of Cancer
- Accession number :
- edsair.doi.dedup.....a6f32712a7380bfa93a2580d83542044