Chanson Noemie, Galvagni Alexandre, Ramos-Casals Manuel, Ruiz Juan Ignacio, Suijkerbuijk Karijn P M, Gente Karolina, Kerschen Philippe, Karam Jean Denis, Belkhir Rakiba, Outh Rodereau, Closs-Prophette Fabienne, Garcia Morillo Jose Salvador, Robles-Marhuenda Ángel, Michot Jean-Marie, Voisin Anne Laure, Messayke Sabine, Laparra Arianne, Robert Caroline, Suarez-Almazor Maria, Mariette Xavier, Lambotte Olivier
Department of Internal Medicine and Clinical Immunology, AP-HP, Université Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, France.
Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.
Rheumatology (Oxford). 2025 Jun 1;64(6):3685-3690. doi: 10.1093/rheumatology/keae711.
To describe presentation, treatment and outcome of immune checkpoint inhibitor (ICI) associated-vasculitis in cancer patients in a multicentre study.
Thanks to the ImmunoCancer International Registry (ICIR), a multidisciplinary network focused on the research of the immune related adverse events related to cancer immunotherapies, patients presenting with a clinical and/or radiological suspicion of vasculitis and histological evidence of vasculitis after being exposed to ICIs were retrospectively identified.
Twenty-eight cases were identified in the ICIR registry. The median interval between starting ICI treatment and vasculitis diagnosis was 4 months. Small vessel vasculitis was predominant (n = 21), followed by large vessel (n = 4) and medium vessel (n = 3). The small vessel vasculitis included 10 unclassified vasculitis either with limited cutaneous involvement (n = 6) or systemic involvement (n = 4), five IgA vasculitis, three cryoglobulinemic vasculitis, and three ANCA+ vasculitis. At presentation or during the evolution, renal and neurologic manifestations were evidenced in seven cases each (25%). Renal biopsies documented immune glomerulopathies in six cases. Only seven patients (25%) fulfilled the 2022 ACR/EULAR classification criteria (four giant cell arteritis, two EGPA and one GPA). Most patients (90%) required systemic corticosteroid and an additional drug was given in 10 patients (36%). Vasculitis outcome was good: 22 patients had vasculitis complete response, no patient died due to vasculitis. Nine patients (32%) were rechallenged with immunotherapy with only one relapse.
ICI-associated vasculitis are rare, heterogeneous, but can be severe requiring urgent multidisciplinary management with aggressive treatment.
在一项多中心研究中描述癌症患者免疫检查点抑制剂（ICI）相关血管炎的表现、治疗及结局。
借助免疫癌症国际登记处（ICIR），一个专注于研究癌症免疫治疗相关免疫相关不良事件的多学科网络，对临床和/或放射学怀疑有血管炎且在接触ICI后有血管炎组织学证据的患者进行回顾性识别。
在ICIR登记处识别出28例病例。开始ICI治疗至血管炎诊断的中位间隔时间为4个月。小血管血管炎占主导（n = 21），其次是大血管（n = 4）和中血管（n = 3）。小血管血管炎包括10例未分类血管炎，其中有限皮肤受累（n = 6）或全身受累（n = 4），5例IgA血管炎，3例冷球蛋白血症性血管炎和3例ANCA阳性血管炎。在就诊时或病程中，肾脏和神经系统表现各有7例（25%）。肾活检记录了6例免疫性肾小球病。只有7例患者（25%）符合2022年美国风湿病学会/欧洲抗风湿病联盟分类标准（4例巨细胞动脉炎，2例嗜酸性肉芽肿性多血管炎和1例肉芽肿性多血管炎）。大多数患者（90%）需要全身使用糖皮质激素，10例患者（36%）还使用了其他药物。血管炎结局良好：22例患者血管炎完全缓解，无患者因血管炎死亡。9例患者（32%）再次接受免疫治疗，仅1例复发。
ICI相关血管炎罕见、异质性强，但可能很严重，需要紧急多学科管理及积极治疗。
