Monday, 28 May 2018

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Rheumatic IRAEs Gaining Speed

Today I was fortunate to be a part of a From Bench to Bedside session on the topic of controlling the balance between cancer and autoimmunity, chaired by Drs. Leonard Calabrese and Xavier Mariette. Rheumatic IRAEs from checkpoint inhibitor therapy are growing rapidly in scope and rheumatologists must be aware of these complications, as they are certain to encounter this type of patient.

The first talk was by Dr. Antony Rosen (JHU) who discussed possible mechanisms underlying cancer in the setting of autoimmune disease, focusing on the strong associated between RNA pol III positive systemic sclerosis and the development of cancer. Next up was Dr. Aurélien Marabelle (France) who spoke from the oncology perspective on the paradigm shift in cancer therapy from drugs that target cancers to these checkpoint inhibitors that target the patient’s own immune system. He stressed the importance of interprofessional care of these patients by oncology and rheumatology.

I was thrilled to present the first abstract on our Cleveland Clinic experience with rheumatic IRAEs thus far. In our experience it seems that rheumatic IRAEs may not be self-limiting like some of the other system IRAEs (skin, gut), but rather here to stay, making the role of the rheumatologist all the more important. Dr. Rakiba Belkhir (Paris) presented the final abstract and shared a case series of 6 patients who developed ACPA-positive RA on checkpoint therapy.

Tak away points stressed that rheumatologists must become familiar with rheumatic IRAEs and engage with oncologists inter-professionally to optimize patient care, as their frequency will continue to increase.

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