Dr. Leonard Calabrese outlines a complex topic
Checkpoint inhibitor therapy for cancer holds great potential for durable response rates, but immune-related adverse events may be its Achilles’ heel. For the millions of individuals with immune-mediated inflammatory diseases (IMIDs), the safety of this therapy is especially in question. In this video, Leonard Calabrese, DO, Director of the RJ Fasenmyer Center for Clinical Immunology within the Department of Rheumatic and Immunologic Diseases, outlines the complexities of this therapy’s use in patients with IMIDs. The video is part of an editorial originally published in Annals of Internal Medicine.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“The development of checkpoint inhibitor cancer immunotherapy has been a great step forward for a wide variety of malignancies. This form of immunotherapy functions to reinvigorate an exhausted cell-mediated immune response, harnessing the specificity of the immune system to fight cancer. As a byproduct of this invigorated immune response are a wide variety of adverse events that we call ‘immune-related adverse events,’ and these have been suggested as the potential Achilles heel of this form of therapy.
One of the great questions moving forward is whether the tens of millions of people who have immune-mediated diseases to begin with — rheumatoid arthritis, psoriasis, Crohn’s disease, [multiple sclerosis] and others — are they candidates for checkpoint inhibitor therapy if and when they develop a malignancy? The reason that we do not know this is that they were censured from the original clinical trials…
While [researchers have] answered some questions regarding this difficult problem, there are many unanswered questions still out there. First of all, since there are tens of millions of people who may ultimately become candidates for checkpoint therapy, where are biomarkers right now and can we develop biomarkers to predict who will develop an [immune-related adverse event] and who won’t? Secondly, if patients require immunosuppressive therapy from the outset for their immunologic disease, will this negate the efficacy of the checkpoint inhibitor therapy for their cancer? Lastly, how will we collect these data and study these data?”
Several factors masked the cause of the patient’s chronic condition
Patient with previous neurological, bone and hematologic involvement presents with hematemesis
Coordinating care across multiple disciplines
A broad differential diagnosis
From methotrexate for RA, to the treatment of HIV and multicenter randomized trials, Cleveland Clinic has long been at the forefront in the field of rheumatology
Study examines the acceptance of PROMs in a large series of rheumatology patients
The identification of a novel disorder: the VEXAS syndrome
Varied platforms maximize opportunities for interactive, problem-based learning