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The spectacular success and rapidly widening use of the immune checkpoint inhibitors in the treatment of cancer has been accompanied by a notable increase in rheumatic immune-related adverse events.
"What the immune checkpoint inhibitors do -- ramping up the immune system through enhancing T cell activity -- is the exact opposite of what we do, which is to suppress the immune system to treat our diseases," he explained.
Multiple rheumatic phenotypes for these adverse events have now been reported and virtually every organ has been affected, with cases of skin rash, colitis, hepatotoxicity, pneumonitis, ocular and renal involvement and even hypophysitis, which was almost unheard of in the past.
What will be required is understanding the balance required between the immune activation needed to control the cancer and the immune suppression that manages the rheumatic disease, he said.