Table 3.
Clinical characteristics and outcomes of patients who flared ICI-IA on rechallenge and those who did not flare
| ICI-IA flare after rechallenge (N=12) | No ICI-IA flare after rechallenge (N=11) |
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| Gender, N (%) | Male | 7 (58.3) | 6 (54.5) |
| Female | 5 (41.7) | 5 (45.5) | |
| Age, median (IQR) | 68.5 (61.4–74.1) | 69.0 (65.3–74.1) | |
| Tumour type, N (%) | Melanoma | 3 (25.0) | 6 (54.5) |
| Lung | 5 (41.7) | 2 (18.2) | |
| Genitourinary | 3 (25) | 1 (9.1) | |
| Other | 1 (8.3) | 2 (18.2) | |
| ICI type (first course), N (%) | CTLA-4 | 0 (0.0) | 1 (9.1) |
| PD1/PDL-1 | 11 (91.7) | 9 (81.8) | |
| Combination | 1 (8.3) | 1 (9.1) | |
| Type of ICI-IA, N (%) | PMR-like | 7 (58.3) | 5 (45.5) |
| Symmetrical polyarthritis | 3 (25.0) | 4 (36.4) | |
| Psoriatic arthritis | 1 (8.3) | 1 (9.1) | |
| Oligoarthritis | 1 (8.3) | 1 (9.1) | |
| CTCAE grade, N (%) | Grade 1 | 5 (41.7) | 3 (27.3) |
| Grade 2 | 4 (33.3) | 5 (45.5) | |
| Grade 3 | 3 (25.0) | 3 (27.3) | |
| Laboratory | CRP (mg/L), median (IQR) | 27.0 (15.5–57.0) | 51.0 (14.3–80.5) |
| Positive RF, n (%) | 2 (16.7) | 1 (9.1) | |
| Positive anti-CCP, n (%) | 2 (16.7) | 0 (0.0) | |
| Imaging | |||
| X-ray, N (%) | OA | 5 (41.7) | 4 (36.4) |
| US, N (%) | Synovitis | 4 (33.3) | 4 (36.4) |
| Tenosynovitis | 4 (33.3) | 3 (27.3) | |
| Bursitis | 6 (50.0) | 3 (27.3) | |
| Time from ICI start to ICI-IA symptoms (first course), median (IQR) | 3.5 (1.0–8.8) | 7.0 (3.5–12.0) | |
| Total duration of the first course of ICI, median (IQR) | 8.5 (5.3–20.5) | 13.0 (8.0–17.0) | |
| Time between cessation of the first course of ICI and rechallenge, median (IQR) | 12.0 (8.7–19.1) | 7.0 (6.0–16.5) | |
| ICI-IA treatment at the moment of rechallenge, N (%) | No treatment | 5 (41.7) | 6 (54.5) |
| Prednisone | 6 (50.0) | 5 (45.5) | |
| Maximal dose, median (IQR) | 5.0 (4.0–7.5) | 5.0 (5.0–5.0) | |
| MTX | 2 (16.7) | 0 (0.0) | |
| Anti-IL6* | 0 (0.0) | 1 (9.1) | |
| ICI-IA disease activity at the time of rechallenge, N (%) | Remission | 10 (83.3) | 8 (72.7) |
| Grade 1 | 2 (16.7) | 3 (27.3) | |
| ICI type (second course), N (%) | CTLA-4 | 0 (0.0) | 0 (0.0) |
| PD1/PDL-1 | 12 (100.0) | 11 (100.0) | |
| Combination | 0 (0.0) | 0 (0.0) | |
| Same ICI as first ICI course, N (%) | 11 (91.7) | 7 (63.6) | |
| Total duration of the second course of ICI, median (IQR) | 4.5 (1.8–7.0) | 6.0 (3.0–7.5) | |
| Progression after ICI rechallenge, N (%) | 7 (58.3) | 9 (81.8) | |
| Progression-free survival after rechallenge, days (IQR) | 152 (75–273) | 91 (61–214) | |
| Death, N (%) | 3 (25.0) | 1 (9.1) | |
| Follow-up after the second course of ICI, median (IQR) | 6.7 (4.5–12.8) | 11.0 (5.5–23.5) | |
None of the differences are statistically significant (all p>0.05).
*Anti-IL-6 started concomitantly to rechallenge given MTX inefficacy.
anti-CCP, anti-cyclic citrullinated peptide; CRP, C reactive protein; CTCAE, Common Terminology Criteria for Adverse Events; ICI, immune checkpoint inhibitors; ICI-IA, ICI-induced inflammatory arthritis; MTX, methotrexate; OA, osteoarthritis; PMR, polymyalgia rheumatica; RF, rheumatoid factor.