Soliman Abram, Hassan Ruba, Codreanu Ion, Plaxe Steven C, Dasanu Constantin A
Department of Medicine, Eisenhower Health, Rancho Mirage, CA, USA.
Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA.
J Oncol Pharm Pract. 2024 Aug 8:10781552241271753. doi: 10.1177/10781552241271753.
Careful adverse event assessment and management are important when prescribing immune checkpoint inhibitors (ICIs) to cancer patients. Iatrogenic Sjogren's syndrome is a relatively rare immune-related adverse event (irAEs) that affects the moisture-producing glands.
We describe a series of four patients who developed Sjogren's syndrome while being treated with ICIs at a community cancer center in Southern California, USA (1/1/2017-12/31/2023). Patient, drug and disease-related data were collected by retrospective chart review. A systematic search of the PubMed database was performed to identify similar cases in the literature (1/1/2016-12/31//2023).
Of 224 cancer patients at our center treated with ICIs, four (1.8%) developed iatrogenic Sjogren's syndrome. All of our patients were male; three received PD-1 inhibitors (nivolumab, pembrolizumab) and one received the PD-L1 inhibitor atezolizumab. The median time to development of Sjogren's syndrome was 24 weeks (range, 8-36 weeks); dry mouth symptoms were more prominent than dry eye symptoms. None of the patients had elevated SS-A, SS-B or antinuclear antibodies. One patient developed multiple tooth cavities and had several extractions, due to severe xerostomia. Management of all patients was primarily symptomatic. Two cases were irreversible; one was reversible and the 4 case is undermined as he is still on ICI therapy. Our systematic review of the literature identified 80 cases in five articles. Incidence of xerostomia was twice of that of xerophthalmia. The male/female ratio was 1.5:1. SS-A, SS-B, or antinuclear antibodies were found in only 9% of patients. Steroids were reported to have had only a limited role in management.
The incidence of Sjogren's syndrome due to ICIs in our center was 1.8%. Details of clinical course and management in these patients are presented. Caring for patients with ICI-related Sjogren's syndrome is facilitated by a multidisciplinary effort including oncologists, otolaryngologists, dentists, ophthalmologists and rheumatologists. Expanding the knowledge base pertaining to iatrogenic Sjogren's syndrome in patients on ICIs will be helpful in promoting early detection and treatment, and improving outcomes.
在为癌症患者开具免疫检查点抑制剂（ICI）时，仔细的不良事件评估和管理至关重要。医源性干燥综合征是一种相对罕见的免疫相关不良事件（irAE），会影响产液腺。
我们描述了在美国南加州一家社区癌症中心接受ICI治疗期间发生干燥综合征的4例患者（2017年1月1日至2023年12月31日）。通过回顾性病历审查收集患者、药物和疾病相关数据。对PubMed数据库进行系统检索，以识别文献中的类似病例（2016年1月1日至2023年12月31日）。
在我们中心接受ICI治疗的224例癌症患者中，4例（1.8%）发生医源性干燥综合征。所有患者均为男性；3例接受PD - 1抑制剂（纳武单抗、帕博利珠单抗），1例接受PD - L1抑制剂阿替利珠单抗。干燥综合征发病的中位时间为24周（范围8 - 36周）；口干症状比干眼症状更突出。所有患者的SS - A、SS - B或抗核抗体均未升高。1例患者因严重口干出现多个龋齿并进行了多次拔牙。所有患者的管理主要是对症治疗。2例不可逆；1例可逆，第4例因仍在接受ICI治疗情况不明。我们对文献的系统评价在5篇文章中确定了80例病例。口干的发生率是干眼的两倍。男女比例为1.5:1。仅9%的患者发现有SS - A、SS - B或抗核抗体。据报道，类固醇在管理中作用有限。
我们中心因ICI导致的干燥综合征发生率为1.8%。本文介绍了这些患者的临床病程和管理细节。包括肿瘤学家、耳鼻喉科医生、牙医、眼科医生和风湿病学家在内的多学科努力有助于护理ICI相关干燥综合征患者。扩大关于接受ICI治疗患者的医源性干燥综合征的知识库将有助于促进早期发现和治疗，并改善治疗结果。
