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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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-09-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2018.00409/full |
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| author | Nikolaos Spathas Panagiota Economopoulou Myrto Cheila Ioannis Kotsantis Antonis Fanouriakis Dimitra Kassara Amanda Psyrri |
| author_facet | Nikolaos Spathas Panagiota Economopoulou Myrto Cheila Ioannis Kotsantis Antonis Fanouriakis Dimitra Kassara Amanda Psyrri |
| author_sort | Nikolaos Spathas |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-14T00:37:37Z |
| format | Article |
| id | doaj.art-48dd6d49989d43b2ad5ff0f065428a8b |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-14T00:37:37Z |
| publishDate | 2018-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-48dd6d49989d43b2ad5ff0f065428a8b2022-12-22T02:22:18ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2018-09-01810.3389/fonc.2018.00409414019Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell CarcinomaNikolaos Spathas0Panagiota Economopoulou1Myrto Cheila2Ioannis Kotsantis3Antonis Fanouriakis4Dimitra Kassara5Amanda Psyrri6Section of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceSection of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceSection of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceSection of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece4th Department of Internal Medicine, Rheumatology and Clinical Immunology, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece4th Department of Internal Medicine, Rheumatology and Clinical Immunology, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceSection of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, GreeceIntroduction: 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.https://www.frontiersin.org/article/10.3389/fonc.2018.00409/fullpembrolizumabinflammatory arthritishead and neck cancerimmune checkpoint inhibitorsimmune-related adverse events |
| spellingShingle | Nikolaos Spathas Panagiota Economopoulou Myrto Cheila Ioannis Kotsantis Antonis Fanouriakis Dimitra Kassara Amanda Psyrri Inflammatory Arthritis Induced by Pembrolizumab in a Patient With Head and Neck Squamous Cell Carcinoma Frontiers in Oncology pembrolizumab inflammatory arthritis head and neck cancer immune checkpoint inhibitors immune-related adverse events |
| 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 | pembrolizumab inflammatory arthritis head and neck cancer immune checkpoint inhibitors immune-related adverse events |
| url | https://www.frontiersin.org/article/10.3389/fonc.2018.00409/full |
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