Kim Sang T, Murphy William A, Aparicio Ana, Subudhi Sumit K
Department of General Internal Medicine, Section of Rheumatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Immunother Precis Oncol. 2020 May 14;3(3):128-132. doi: 10.36401/JIPO-20-2. eCollection 2020 Aug.
Immune checkpoint inhibitors (ICIs) are often associated with inflammatory toxicities known as immune-related adverse events (irAEs). Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is an atypical inflammatory arthritis. Herein, we report a case of RS3PE in a patient with metastatic prostate cancer who was receiving a combination of second-generation hormonal therapies plus ipilimumab.
A 59-year-old man with metastatic prostate cancer developed sudden onset of pain and swelling of the right hand after 15 weeks of treatment with second-generation hormonal therapies plus three cycles of ipilimumab. Symptoms alternated to the left hand. Physical examination showed tender, pitting edema of the left hand with tenderness on the right second through fifth metacarpal phalangeal joints, leading to the diagnosis of RS3PE. Ipilimumab was withheld, and the RS3PE self-resolved; however, 1 month later, the patient had another flare of RS3PE. A bone scan showed active inflammation on bilateral wrists and hands. Methotrexate was initiated, and his symptoms resolved over a few days. Methotrexate was discontinued 2 months later, and RS3PE has been in complete remission. His prostate cancer progressed, and radium-223 treatment was initiated.
To the best of our knowledge, this is the first reported case of RS3PE after the combined second-generation hormonal therapy plus ipilimumab. Both rheumatologists and oncologists should be aware that RS3PE can develop as an irAE. Understanding the mechanism of ICI therapy-associated RS3PE is critical to identify predictive biomarkers and develop optimal therapeutic strategies that do not sacrifice antitumor immunity.
免疫检查点抑制剂（ICI）常与称为免疫相关不良事件（irAE）的炎症毒性相关。缓解性血清阴性对称性滑膜炎伴凹陷性水肿（RS3PE）是一种非典型炎症性关节炎。在此，我们报告一例转移性前列腺癌患者发生RS3PE的病例，该患者正在接受第二代激素疗法联合伊匹木单抗治疗。
一名59岁的转移性前列腺癌男性患者，在接受第二代激素疗法加三个周期伊匹木单抗治疗15周后，右手突然出现疼痛和肿胀。症状随后转移至左手。体格检查显示左手有压痛和凹陷性水肿，右手第二至第五掌指关节有压痛，从而诊断为RS3PE。停用伊匹木单抗后，RS3PE自行缓解；然而，1个月后，患者再次出现RS3PE发作。骨扫描显示双侧手腕和手部有活动性炎症。开始使用甲氨蝶呤治疗，患者症状在几天内缓解。2个月后停用甲氨蝶呤，RS3PE一直处于完全缓解状态。他的前列腺癌进展，开始进行镭-223治疗。
据我们所知，这是首例第二代激素疗法联合伊匹木单抗治疗后发生RS3PE的报告病例。风湿病学家和肿瘤学家都应意识到RS3PE可作为一种irAE发生。了解ICI治疗相关RS3PE的机制对于识别预测性生物标志物和制定不牺牲抗肿瘤免疫力的最佳治疗策略至关重要。
