• Shahin Jamal, Marie Hudson, Aurore Fifi-Mah, and Carrie Ye.
• From the Division of Rheumatology, Vancouver General Hospital, and Department of Medicine, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Jewish General Hospital and Lady Davis Institute; Department of Medicine, McGill University, Montreal, Quebec; Division of Rheumatology, University of Calgary, Calgary; Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Shahin.jamal@vch.ca.
• J Rheumatol. 2020 Feb 1; 47 (2): 166-175.

AbstractImmune checkpoint inhibitors have revolutionized cancer therapy by blocking inhibitory pathways of the immune system to fight cancer cells. Their use is often limited by the development of autoimmune toxicities, which can affect multiple organ systems and are referred to as immune-related adverse events (irAE). Among these are rheumatologic irAE, including inflammatory arthritis, myositis, vasculitis, and others. Rheumatologic irAE seem to be different from irAE in other organs and from traditional autoimmune diseases in that they can occur early or have delayed onset, and can persist chronically, even after cancer therapy is terminated. Because immune checkpoint inhibitors are increasingly used for many types of cancer, it is important for oncologists and rheumatologists to recognize and manage toxicities early. In this review, we discuss currently approved immune checkpoint inhibitors and their mechanisms of action and systemic toxicities, with a focus on the management and effect on further cancer therapy of rheumatic irAE.

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