Exacerbation of symptoms of rheumatoid arthritis in the course of immunotherapy of non-small cell lung cancer - an analysis of medical cases and a review of the literature

Bargieł, Julia, Cabaj, Justyna, Chmielewska, Izabela, Wójcik-Superczyńska, Magdalena, Milanowski, Janusz. Exacerbation of symptoms of rheumatoid arthritis in the course of immunotherapy of non-small cell lung cancer - an analysis of medical cases and a review of the literature. Journal of Education, Health and Sport. 2022;12(9):856-866. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2022.12.09.099 https://apcz.umk.pl/JEHS/article/view/39968 https://zenodo.org/record/7085623 The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 21, 2021. No. 32343. Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences). Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 21 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159. Przypisane dyscypliny naukowe: Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu). © The Authors 2022; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 01.09.2022. Revised: 02.09.2022. Accepted: 16.09.2022. Exacerbation of symptoms of rheumatoid arthritis in the course of immunotherapy of non-small cell lung cancer - an analysis of medical cases and a review of the literature Zaostrzenie objawów reumatoidalnego zapalenia stawów w przebiegu immunoterapii niedrobnokomórkowego raka płuca - analiza przypadków medycznych oraz przegląd literatury Julia Bargieł Student Research Group at the Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin https://orcid.org/0000-0002-1388-8243 Justyna Cabaj Student Research Group at the Chair and Department of Pneumology, Oncology and Allergology, Medical University of Lublin https://orcid.org/0000-0002-1394-0638 Izabela Chmielewska Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin https://orcid.org/0000-0002-0948-9071 Magdalena Wójcik-Superczyńska Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin https://orcid.org/0000-0001-9153-9850 Janusz Milanowski Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin https://orcid.org/0000-0002-8616-596X Abstract Background: Lung cancer has been at the forefront of cancers with the highest incidence and mortality rates. Nowadays, there are available more effective forms of treatment such as immunotherapy. In the case of cancer cells expressing the PD-L1 receptor, pembrolizumab, atezolizumab and nivolmab are of particular use. While these drugs have the great benefit of stabilizing the disease, they are not without side effects, especially inflammatory changes in the joints. The aim of the study is to show the risk of immunotherapy in the form of exacerbation of inflammatory symptoms in patients with rheumatoid arthritis (RA) as a concomitant disease. Case report: Lung cancer (PD-L1 +) was diagnosed in three patients with a history of RA. After meeting the criteria of the drug program, the patients started molecularly targeted therapy with pembrolizumab and atezolizumab. The applied treatment brought a great benefit in the form of stabilization the neoplastic disease. Over time an exacerbation of inflammatory changes within the joints was noted, which significantly impeded everyday functioning in two patients. Due to this situation, immunotherapy was discontinued. Conlusions: Studies show that as many as 1/4 of patients treated with PD-L1 inhibitors experience side effects related to the autoimmune system. In the case of people suffering from RA, the use of immunotherapy may intensify inflammatory changes and increase pain, which significantly reduce the quality of life. Therefore, the risk of RA exacerbation as a side effect of biological therapy for lung cancer treatment should be popularized. This awareness will enable quick intervention and minimize the number of interrupted immunotherapies. Keywords: oncology, immunotherapy, lung cancer, rheumatic disease