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Musculoskeletal immune-related adverse events in 927 patients treated with immune checkpoint inhibitors for solid cancer

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? 2022 Société fran?aise de rhumatologieObjective: The prevalence of the musculoskeletal immune-related adverse events (irAEs) is probably underestimated, as most studies report only severe side effects. Our aim was to describe and characterize all musculoskeletal irAEs in a large cohort of patients treated with immune checkpoint inhibitors (ICI). Methods: We conducted a retrospective study among patients who received ICI from 07/27/2014 to 05/08/2020 at the medical oncology department of the Institut Paoli-Calmettes, Marseille, France. All medical files were systemically reviewed by a rheumatologist who collected clinical features, time of occurrence, treatment regimen, irAEs management, course and outcomes. We also assessed tumor response 3 months after introduction of ICI, according to severity and treatments used to manage musculoskeletal irAEs. Results: Among 927 patients treated with ICI for a solid tumor, 118 patients (12.7) presented a musculoskeletal irAE. Their median age was 66.5, 61 were male, and they mainly had a lung (57.6) or urological cancer (27.1). The most frequently involved ICI was an anti PD-1. Arthralgias and myalgias were the most frequent musculoskeletal irAEs (9.8) and inflammatory rheumatic features were reported in 36 patients (3.9) with elevated acute phase reactants and negative immunological markers. The median time of onset was 2 months (IC 95 1.8; 2.7). Tumor response at 3 months did not differ according to musculoskeletal irAE severity, type of manifestation (arthralgias/myalgias versus inflammatory rheumatic features), pain patterns (mechanical versus inflammatory) or irAE treatments. Conclusion: Musculoskeletal irAEs in this large cohort of patients treated with ICI were frequent (12.7), mostly mild and well tolerated.

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