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

Table 2.

Reported cases of sicca syndrome induced by ICIs 1, 3, 4, 6, 7, 8, 9, 10

Article No. of sicca syndrome cases/all enrolled patients Metastatic cancer ICI Time to onset, wk Clinical gradinga Accessory salivary glands biopsy ANA Anti‐SSA/SSB Other irAEs
Calabrese et al. 2017

  • 5/13

 Renal cell carcinoma, melanoma Anti‐PD1 alone or + anti‐CTLA‐4; anti‐PD‐L1 alone 2–21.9 Not specified Not performed 2/5 1/5 anti‐SSA

  • Polymyalgia rheumatica

  • Arthritis

  • Keratoconjunctivitis
Cappelli et al. 2017

  • 4/13 (1/4 with bilateral parotid gland swelling)

 NSCLC, melanoma Anti‐PD1 alone; anti‐CTLA‐4 alone; Combination 8–32 Not specified Not performed

3/4

1/4 rheumatoid factor

 1/4 anti‐SSB

  • Pneumonitis

  • Nephritis

  • Colitis
Teyssonneau et al. 2017

  • 1 case reported (1 Sjögren‐like syndrome)

 Parotid actinic cell carcinoma Anti‐PD1 33 2 Not performed Negative Negative

  • Skin rash

  • Dry eyes
Le Burel et al. 2018
  • 3/447

(3 Sjogren's syndrome)

 Renal cell carcinoma, squamous cell carcinoma of the cervix, melanoma Anti‐PD1 alone or + anti‐CTLA‐4; anti‐PD1 + anti‐BRAF+ anti‐MEK 8–12 2–3 Performed in 2 cases 3/3

‐ Anti‐SSA positive prior to ICI in 2 cases

‐ Anti‐SSA positive in 1 case

  • Dry eyes

  • Arthralgia

  • Myalgia

  • Paresthesia
Takahashi et al. 2018

  • 1

 NSCLC Anti‐PD1 16 Not specified Performed, severe sialadenitis Negative Negative

  • Colitis
Ghosn et al. 2018

  • 1 (Sjogren's syndrome)

 Melanoma Anti‐PD1 32 Not specified Performed, Chisholm‐Mason score 3 Positive Anti‐SSA positive

  • Neuro‐Sjögren's syndrome
Narváez et al. 2018

  • 2/11

 NSCLC, pancreatic neuroendocrine cancer Anti‐PD1 15–24 Not specified Not performed Positive Negative

  • Thyroiditis

  • Hypothyroidism
Warner et al. 2019

  • 20/20

 Metastatic melanoma; non‐small cell lung carcinoma; metastatic prostate cancer; adenocarcinoma, gastroesophageal junction; metastatic thymic carcinoma; recurrent respiratory papillomatosis Anti‐PD1, alone or + anti‐CTLA‐4, anti‐PD‐L1, alone or + TGF‐beta 2–29

1 (5)

2 (15)

Focus score 0 (10)

FS 1 (4)

FS 2 (2)

 3/20 2/20

  • Dermatitis

  • Adrenal insufficiency

  • Thyroiditis

  • Colitis

  • Cardiomyopathy

  • Hypophysitis

  • Encephalitis

  • Rheumatoid arthritis flare

  • Mucositis

  • Elevated CK

graphic file with name ONCO-25-e391-g005.jpg

aNCI‐CTCAE v.5.0.

Abbreviations: ANA, antinuclear antibodies; CK, creatine kinase; CTLA‐4, cytotoxic T‐lymphocyte‐associated protein 4; FS, focus score; ICI, immune checkpoint inhibitor; irAE, immune‐related adverse event; NCI‐CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events; NSCLC, non‐small cell lung cancer; 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; TGF, transforming growth factor.