impact factor, citescore
logo
 

Full Papers

 

Clinical outcomes in cancer patients with immune checkpoint inhibitor-induced arthritis treated with methotrexate: a retrospective longitudinal monocentric pilot study


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

 

  1. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, and Department of Experimental Medicine (DIMES), University of Genova, Italy.
  2. IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  3. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  4. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, Italy.
  5. Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genova, and Department of Internal Medicine and Medical Specialties, University of Genova, Italy.
  6. Department of Internal Medicine and Medical Specialties, University of Genova, and Medical Oncology Clinic 2, Department of Internal Medicine, University of Genova, Italy.
  7. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  8. Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital; and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium.
  9. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  10. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy. mcutolo@unige.it
  11. Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, Genova, and IRCCS Ospedale Policlinico San Martino, Genova, Italy.

CER18297
Full Papers

purchase article

PMID: 39907616 [PubMed]

Received: 01/11/2024
Accepted : 15/01/2025
In Press: 24/01/2025

Abstract

OBJECTIVES:
Immune-mediated adverse events (irAEs) from immune checkpoint inhibitors (ICIs) often require high-dose glucocorticoids (GCs), which can promote cancer progression and counteract ICI benefits. This study evaluated the articular and oncologic clinical outcomes of ICI-induced arthritis treated with methotrexate (MTX) as a GC-sparing agent.
METHODS:
Adult patients with ICI-induced arthritis in 2023 were included. Arthritis was assessed using the disease activity score on 28 joints by C-reactive protein (DAS28-CRP), with follow-ups every 3 months. All patients received subcutaneous MTX, and oncologic outcomes were evaluated using RECIST 1.1 criteria after one year.
RESULTS:
Fourteen patients (median age 74.5 years) with melanoma (64.3%), colorectal cancer (14.3%), lung cancer (14.3%), or Hodgkin’s lymphoma (7.1%) were treated with PD1 antagonists (92.9%) or combined with CTLA4 blockers (7.1%). Arthritis presentations included oligo-arthritis (36%), mono-arthritis (29%), polyarthritis (21%), and polymyalgia rheumatica-like syndrome (14.3%), with a mean onset of 4.7±3.7 months post-ICI. MTX was started for all at a mean dose of 9.5±1.5 mg weekly, beginning at the first rheumatology visit in 78.5% of patients. Over a mean follow-up of 12.8±4.6 months, DAS28-CRP scores improved significantly, and prednisone dosage was in all reduced (3.6 mg at V4 vs. 8.4 mg at V0, p=0.003). No major MTX-related toxicities were noted. Cancer responses at follow-up were complete (50%), partial (21.4%), stable disease (7.1%), and progression (21.5%).
CONCLUSIONS:
The use of MTX in ICI-induced arthritis showed promising results in reducing GC dosages and managing the inflammatory articular activity, with no major toxicities observed over one year. These findings suggest that MTX may be a viable GC-sparing option in this context, but larger, controlled studies are needed to confirm these observations and better understand the impact on both articular and oncologic outcomes.

DOI: https://doi.org/10.55563/clinexprheumatol/e49am5

Rheumatology Article