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Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma

Introduction: T cell checkpoint inhibitors targeting Programmed cell Death protein-1 (PD-1) have emerged as novel immunotherapy agents showing remarkable efficacy in head and neck squamous cell carcinoma (HNSCC). Despite important clinical benefits, they are associated with side effects that occur a...

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Autores principales: Spathas, Nikolaos, Economopoulou, Panagiota, Cheila, Myrto, Kotsantis, Ioannis, Fanouriakis, Antonis, Kassara, Dimitra, Psyrri, Amanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168664/
https://www.ncbi.nlm.nih.gov/pubmed/30319973
http://dx.doi.org/10.3389/fonc.2018.00409
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author Spathas, Nikolaos
Economopoulou, Panagiota
Cheila, Myrto
Kotsantis, Ioannis
Fanouriakis, Antonis
Kassara, Dimitra
Psyrri, Amanda
author_facet Spathas, Nikolaos
Economopoulou, Panagiota
Cheila, Myrto
Kotsantis, Ioannis
Fanouriakis, Antonis
Kassara, Dimitra
Psyrri, Amanda
author_sort Spathas, Nikolaos
collection PubMed
description Introduction: T cell checkpoint inhibitors targeting Programmed cell Death protein-1 (PD-1) have emerged as novel immunotherapy agents showing remarkable efficacy in head and neck squamous cell carcinoma (HNSCC). Despite important clinical benefits, they are associated with side effects that occur as a consequence of general immunological stimulation due to loss of T cell inhibition. Herein, we report the unusual case of inflammatory arthritis induced by anti-PD-1 agent pembrolizumab. Case report: A 55-years old male was treated with pembrolizumab at a dose of 200 mg every 3 weeks for a metastatic hypopharyngeal carcinoma. Following two cycles of immunotherapy, and while complete response of lung metastases was achieved, the patient presented with stiffness, swelling and pain of the right knee. Clinical examination and synovial fluid analysis revealed a seronegative inflammatory arthritis. Pembrolizumab therapy was interrupted and low-dose prednisone was administered with remarkable clinical improvement. Pembrolizumab was reintroduced, but after the fifth cycle, the patient developed inflammatory polyarthritis involving both knees and interphalangeal joints of both hands resulting in severe clinical deterioration. At that time, treatment with pembrolizumab was permanently discontinued. High-dose prednisone and methotrexate treatment led to remission of clinical symptoms. Conclusion: Pembrolizumab-induced inflammatory arthritis is an unusual rheumatic immune-related adverse event that physicians are likely to encounter as ICI use expands. Multidisciplinary management and rheumatology consultation are necessary to provide immediate treatment and avoid permanent joint damage.
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spelling pubmed-61686642018-10-12 Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma Spathas, Nikolaos Economopoulou, Panagiota Cheila, Myrto Kotsantis, Ioannis Fanouriakis, Antonis Kassara, Dimitra Psyrri, Amanda Front Oncol Oncology Introduction: T cell checkpoint inhibitors targeting Programmed cell Death protein-1 (PD-1) have emerged as novel immunotherapy agents showing remarkable efficacy in head and neck squamous cell carcinoma (HNSCC). Despite important clinical benefits, they are associated with side effects that occur as a consequence of general immunological stimulation due to loss of T cell inhibition. Herein, we report the unusual case of inflammatory arthritis induced by anti-PD-1 agent pembrolizumab. Case report: A 55-years old male was treated with pembrolizumab at a dose of 200 mg every 3 weeks for a metastatic hypopharyngeal carcinoma. Following two cycles of immunotherapy, and while complete response of lung metastases was achieved, the patient presented with stiffness, swelling and pain of the right knee. Clinical examination and synovial fluid analysis revealed a seronegative inflammatory arthritis. Pembrolizumab therapy was interrupted and low-dose prednisone was administered with remarkable clinical improvement. Pembrolizumab was reintroduced, but after the fifth cycle, the patient developed inflammatory polyarthritis involving both knees and interphalangeal joints of both hands resulting in severe clinical deterioration. At that time, treatment with pembrolizumab was permanently discontinued. High-dose prednisone and methotrexate treatment led to remission of clinical symptoms. Conclusion: Pembrolizumab-induced inflammatory arthritis is an unusual rheumatic immune-related adverse event that physicians are likely to encounter as ICI use expands. Multidisciplinary management and rheumatology consultation are necessary to provide immediate treatment and avoid permanent joint damage. Frontiers Media S.A. 2018-09-26 /pmc/articles/PMC6168664/ /pubmed/30319973 http://dx.doi.org/10.3389/fonc.2018.00409 Text en Copyright © 2018 Spathas, Economopoulou, Cheila, Kotsantis, Fanouriakis, Kassara and Psyrri. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Spathas, Nikolaos
Economopoulou, Panagiota
Cheila, Myrto
Kotsantis, Ioannis
Fanouriakis, Antonis
Kassara, Dimitra
Psyrri, Amanda
Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma
title Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma
title_full Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma
title_fullStr Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma
title_full_unstemmed Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma
title_short Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma
title_sort inflammatory arthritis induced by pembrolizumab in a patient with head and neck squamous cell carcinoma
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168664/
https://www.ncbi.nlm.nih.gov/pubmed/30319973
http://dx.doi.org/10.3389/fonc.2018.00409
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