Viewpoint: the role of the rheumatologist in managing immune-related adverse events caused by cancer immunotherapy

Rheumatologists should be central figures in this evolving field.

Immune checkpoint inhibitors are a type of immunotherapy used to treat cancer. There are six drugs in this group, and they are used in more than 10 cancer types. This type of treatment for cancer is now very common and there are hundreds of thousands of people being treated around the world. Although the treatments are very positive for many people, there is a risk of developing an autoimmune or inflammatory disease as a side effect of the way the drugs interact with the immune system. These autoimmune diseases include rheumatoid-like arthritis, severe diabetes, thyroid disease, inflammatory bowel disease or psoriasis. These are called
immune-related adverse events (sometimes shortened to irAEs).
Since the number of people receiving these type of cancer treatment is growing rapidly, it is important that all rheumatologists learn more about this immune related Adverse Events. Rheumatologists are doctors with special expertise in autoimmune diseases and the drugs used to treat them. Rheumatologists are now actively working with oncologists (cancer doctors) to battle these immune-related complications in people with cancer.

The authors wanted to share their viewpoint on the role of the rheumatologist in managing immune-related adverse events of cancer drugs.

The authors believe that rheumatologists are well positioned to help manage people with immune-related adverse events, particularly where people needing cancer treatment have a pre-existing autoimmune disease, or are more at risk of developing one. Rheumatologists are the most experienced of all specialists in diagnosing and managing multi-system autoimmune diseases and can work with the cancer team early on to monitor and
manage complications.

If you are taking an immune checkpoint inhibitor to treat your cancer, the most important thing is that you must not stop taking it. Treating the cancer is the main goal.

If you get an autoimmune side effect as a result of your cancer treatment, there are effective drugs that can be used. Your care team will let you know which side effects or symptoms to look out for. If you do develop an immune-related adverse event then you may have to see a rheumatologist as well as your oncology team.
If you have concerns about your disease or its treatment, you should speak to the doctor involved in your care.

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Date prepared: February 2018
Summary based on research article published on: 12 January 2018
From: Calabrese, L. and Mariette, X. The evolving role of the rheumatologist in the management of immune related adverse events (irAEs) caused by cancer immunotherapy. Ann Rheum Dis 2018;77:162–164. doi:annrheumdis-2017-212061

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