Mater Cancer Care Centre, Mater Health Services, South Brisbane, Queensland, Australia.
Department of Palliative Care, St Vincent's Private Hospital Brisbane, Kangaroo Point, Queensland, Australia.
Cancer Rep (Hoboken). 2020 Jun;3(3):e1244. doi: 10.1002/cnr2.1244. Epub 2020 Apr 6.
Immune checkpoint inhibitor (ICI) therapy has revolutionised the treatment of several cancers but can also lead to the development of immune-related adverse effects including dermatologic, gastrointestinal, endocrine, hepatic, pulmonary and less commonly, rheumatic toxicities. Toxicities associated with ICI therapy can occur several months or even years after initiation. Case reports of polymyalgia rheumatica (PMR) associated with nivolumab use are rare. We herein describe, for the first time, a case of PMR in a melanoma patient after cessation of treatment with nivolumab.
An 88-year-old man with a history of stage IV M1c BRAF wild-type melanoma presented with a 1 month history of arthralgias and morning stiffness, predominantly affecting the shoulders and hips, associated with fatigue and weight loss. He had undergone wide local excision of a primary malignant melanoma in the left buttock region several years prior. Immunotherapy with nivolumab was initiated following disease relapse with multiple metastases. Nivolumab was discontinued due to demonstration of complete metabolic response on serial positron emission and computed tomography scans. Symptoms appeared 11 months after completion of treatment. A diagnosis of PMR was made and treatment with oral prednisone was initiated leading to complete resolution of symptoms within 1 week. We believe that the development of PMR in our patient was likely precipitated by nivolumab.
This case demonstrates that PMR, although rare, may occur as an adverse effect both during and after treatment with nivolumab, leading to disabling symptoms and poor quality of life. Prompt diagnosis is crucial to enable timely commencement of corticosteroid therapy in order to avoid further impact on morbidity and mortality for cancer patients. This case highlights the importance of prompt referral to rheumatology, as well as the need for close collaboration between oncologists and rheumatologists to accurately diagnose and successfully manage these patients.
免疫检查点抑制剂（ICI）治疗已经彻底改变了多种癌症的治疗方法，但也可能导致免疫相关的不良反应，包括皮肤、胃肠道、内分泌、肝脏、肺部，以及较少见的风湿毒性。ICI 治疗相关的毒性可能在开始治疗后的数月甚至数年内发生。与 nivolumab 相关使用的巨细胞动脉炎（PMR）的病例报告很少见。本文首次描述了一例 nivolumab 治疗停止后黑色素瘤患者的 PMR。
一名 88 岁男性，有 IV 期 M1c BRAF 野生型黑色素瘤病史，因关节痛和晨僵 1 个月就诊，主要影响肩部和臀部，伴有疲劳和体重减轻。几年前，他曾在左臀部区域接受过原发性恶性黑色素瘤的广泛局部切除。在疾病复发并出现多个转移后，开始进行免疫治疗，使用 nivolumab。由于连续正电子发射和计算机断层扫描显示完全代谢反应，停止了 nivolumab 的治疗。症状在治疗完成后 11 个月出现。诊断为 PMR，并开始口服泼尼松治疗，1 周内症状完全缓解。我们认为，我们患者的 PMR 是由 nivolumab 引起的。
该病例表明，PMR 虽然罕见，但可能在使用 nivolumab 期间和之后发生，导致致残症状和生活质量下降。及时诊断对于开始皮质类固醇治疗至关重要，以避免进一步影响癌症患者的发病率和死亡率。该病例强调了及时转至风湿病科的重要性，以及肿瘤学家和风湿病学家之间密切合作的必要性，以准确诊断和成功管理这些患者。
