Skill Checkup: A 48-Year-Old Triple-Negative Breast Cancer Patient Falls Ill During Immune Checkpoint Inhibitor Therapy

Kelly E. McCann, MD, PhD


May 24, 2022

The most common IRAEs affect the skin, endocrine glands (particularly the thyroid), gastrointestinal system, and liver but can impact almost any organ system. The most common toxicity is rash followed by colitis, endocrinopathies, such as thyroiditis, and then hepatitis. Other less frequent toxicities involve the cardiovascular, pulmonary, ocular, central nervous, and musculoskeletal systems. Recognizing relatively nonspecific rheumatologic and musculoskeletal IRAEs in patients actively undergoing cancer treatment can present a diagnostic challenge owing to a high frequency of such symptoms.

Treatment-related adverse events, distinct from IRAEs, are observed more frequently when an ICI is combined with cytotoxic chemotherapy. Although IRAE rates are similar in patients treated with combination therapy as compared with those treated with ICI monotherapy, pneumonitis in particular does appear to occur more often with combination therapy; the incidence of pneumonitis was higher in breast cancer patients treated with ICI and chemotherapy than with chemotherapy alone in the IMpassion130 trial with atezolizumab and nabpaclitaxel, the first US Food and Drug Administration (FDA)-approved regimen for patients with TNBC. The FDA's conditional approval was contingent upon the success of IMpassion131, which failed to show an improvement in outcomes for atezolizumab plus paclitaxel over paclitaxel alone.


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