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letter
. 2019 Nov 6;25(2):e391–e395. doi: 10.1634/theoncologist.2019-0467

Table 1.

Clinical, histological, and immunostaining features of sicca syndrome in patients treated with ICIs

Patient no. (sex/age, yr) Metastatic cancer ICI Time to onset, wk Clinical gradinga Histologicalb ± immunostaining features Immunological findings Other irAEs Management and outcome/tumor response to ICI
1 (M/42) Renal adenocarcinoma Anti‐PD1 36 2 0 (no lymphocytic infiltrate) Anti‐SSA/SSB: negative

  • Pruritus

  • Psoriasis

  • Xerophthalmia

  • Myalgia and arthralgia

  • No specific symptomatic measures

  • Tumor response: ICI continued
2 (M/60) Melanoma Anti‐PD1 + ICI under development 4 1 0 Anti‐SSA/SSB: negative

  • Psoriasiform eruption

  • Hemorrhagic rectocolitis

  • Acute pancreatitis

  • Xerophthalmia

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor progression: ICI discontinued
3 (F/61) Oral squamous cell carcinoma Anti‐PD1 + ICI under development 4 2 1 Anti‐SSA/SSB: negative

  • Myalgia

  • Hypothyroidism

  • Pruritus

  • Dysgeusia

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor progression: ICI discontinued
4 (F/78) Melanoma Anti‐PD1 + anti‐CTLA‐4 8 2 2 Anti‐SSA/SSB: negative

  • Exanthema

  • Vitiligo

  • Hepatic cytolysis

  • Hypothyroidism

  • Xerophthalmia

  • Symptomatic measuresc for xerostomia + short course of oral corticotherapy (1 mg/kg/day) for grade 3 hepatic cytolisis: improvement

  • Tumor stability: ICI discontinued because of hepatic cytolysis
5 (M/63) Oral squamous cell carcinoma Anti‐PD1 8 3 2 Anti‐SSA/SSB: negative

  • Eczematiform reaction

  • Pruritus

  • Dysgeusia

  • Symptomatic measuresc for xerostomia: no information about outcomes

  • Follow‐up discontinued by patient
6 (F/65) Endometrial adenocarcinoma Anti‐PD1 28 3 0 Anti‐SSA/SSB: negative

  • Myalgia

  • Xerophthalmia

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor progression: ICI discontinued
7 (F/71) Endometrial adenocarcinoma Anti‐PD1 8 2 0 Anti‐SSA/SSB: negative

  • Xerosis

  • Xerophthalmia

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor progression: ICI discontinued
8 (M/68) Renal adenocarcinoma Anti‐ PD1 12 3 1 Anti‐SSA/SSB: negative

  • Myalgia

  • Palmar desquamation

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor progression: ICI discontinued
9 (F/76) Melanoma Anti‐PD1 68 2 2 (2/3 T cells CD4+, 1/3 T cells CD8+) Anti‐SSA/SSB: negative

  • Xerosis

  • Prurigo

  • Xerophthalmia

  • Symptomatic measuresc for xerostomia: no improvement

  • Tumor stability: ICI continued
10 (F/47) Melanoma Anti‐PD1 + anti‐CTLA‐4 20 1 2 Anti‐SSA/SSB: negative

  • Sarcoidosis‐like

  • Hepatitis

  • Nephritis

  • No specific symptomatic measures

  • Patient died
11 (F/39) Melanoma Anti‐PD1 + anti‐CTLA‐4 2 3 3 (2/3 T cells CD4+, 1/3 CD8+) Anti‐SSA/SSB: negative

  • Myalgia

  • Hepatic cytolysis

  • Erythema nodosum

  • Xerosis

  • Parotid glands swelling

  • Symptomatic measuresc for xerostomia + short course of oral corticotherapy (1 mg/kg/day) for grade 3 hepatic cytolysis: improvement

  • Tumor stability: ICI discontinued because of hepatic cytolysis
12 (M/74) Non‐small cell lung carcinoma Anti‐PD1 16 3 2 (2/3 T cells CD4+, 1/3 T cells CD8+) Anti‐SSA/SSB: negative

  • Xerosis

  • Symptomatic measuresc for xerostomia: no information about outcomes

  • Follow‐up discontinued by patient
13 (M/62) Pancreatic adenocarcinoma Anti‐PD1 + ICI under development 28 2 1 (2/3 T cells CD4+, 1/3 T cells CD8+) Anti‐SSA/SSB: negative

  • Skin rash

  • Arthralgia

  • Dysgeusia

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor response: ICI continued
14 (M/74) Melanoma Anti‐PD1 + ICI under development 12 2 1 (2/3 T cells CD4+, 1/3 T cells CD8+) Anti‐SSA/SSB: negative

  • Pruritus

  • Hypothyroidism

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor progression: ICI discontinued
15 (M/69) Oral squamous cell carcinoma Anti‐PD‐L1 4 3 4 (2/3 T cells CD4+, 1/3 T cells CD8+)

Positive anti‐SSA/SSB

Positive rheumatoid factor

Cryoglobulinemia

  • Xerophthalmia

  • Hypothyroidism

  • Symptomatic measuresc for xerostomia: mild improvement

  • Tumor stability: ICI continued

graphic file with name ONCO-25-e391-g004.jpg

a

NCI‐CTCAE v.5.0.

b

Chisholm‐Mason grade.

c

Symptomatic measures for xerostomia: hydration, gum, oral hygiene, anetholtrithione/pilocarpine, salivary substitute.

Abbreviations: CTLA‐4, cytotoxic T‐lymphocyte‐associated protein 4; F, female; ICI, immune checkpoint inhibitor; irAE, immune‐related adverse event; M, male; NCI‐CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; PD1, programmed cell death protein 1; PD‐L1, programmed death‐ligand 1; SSA, anti‐Sjögren's‐syndrome‐related antigen A; SSB, anti‐Sjögren's‐syndrome‐related antigen B.