Macklin Michael, Yadav Sudeep, Jan Reem, Reid Pankti
Section of Rheumatology, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA.
Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago Medical Center, Chicago, IL 60637, USA.
Pharmaceuticals (Basel). 2023 Feb 8;16(2):259. doi: 10.3390/ph16020259.
Immune checkpoint inhibitors (ICI) are the standard of care for various malignancies and have been associated with a wide spectrum of complications that are phenotypically akin to primary autoimmune diseases. While the literature on these toxicities is growing, there is a paucity of data regarding ICI-associated scleroderma which can carry significant morbidity and limit the ability to continue effective ICI therapy. Our review aimed to analyze the current literature on ICI-associated systemic scleroderma (ICI-SSc) and key scleroderma mimics. Cases of ICI-SSc had notable differences from primary SSc, such as fewer vascular features and less seropositivity (such as scleroderma-specific antibodies and antinuclear antibodies). We found that patients with a diagnosis of SSc prior to the start of ICI can also experience flares of pre-existing disease after ICI treatment used for their cancer. Regarding scleroderma mimics, several cases of ICI-eosinophilic fasciitis have also been described with variable clinical presentations and courses. We found no cases of scleroderma mimics: ICI-scleromyxedema or ICI-scleroedema. There is a critical need for multi-institutional efforts to collaborate on developing a patient database and conducting robust, prospective research on ICI-scleroderma. This will ultimately facilitate more effective clinical evaluations and management for ICI-scleroderma.
免疫检查点抑制剂（ICI）是多种恶性肿瘤的标准治疗方法，并且与一系列临床表现类似于原发性自身免疫性疾病的并发症相关。虽然关于这些毒性的文献在不断增加，但关于ICI相关硬皮病的数据却很匮乏，这种疾病可能导致严重的发病率，并限制继续进行有效ICI治疗的能力。我们的综述旨在分析当前关于ICI相关系统性硬皮病（ICI-SSc）和主要硬皮病模仿症的文献。ICI-SSc病例与原发性SSc有显著差异，例如血管特征较少和血清阳性率较低（如硬皮病特异性抗体和抗核抗体）。我们发现，在开始使用ICI之前被诊断为SSc的患者，在接受用于治疗癌症的ICI治疗后，也可能出现原有疾病的发作。关于硬皮病模仿症，也有几例ICI相关嗜酸性筋膜炎的病例被描述，其临床表现和病程各不相同。我们没有发现硬皮病模仿症的病例：ICI相关硬化黏液水肿或ICI相关硬化性水肿。迫切需要多机构合作，建立一个患者数据库，并对ICI相关硬皮病进行有力的前瞻性研究。这最终将有助于对ICI相关硬皮病进行更有效的临床评估和管理。
