Keywords
immune-mediated arthritis
immunotherapy
malignant melanoma
nivolumab
Categories
How to Cite
Abstract
Malignant melanoma is an aggressive skin tumor that accounts for 1% of all skin tumors. Immunotherapy is a new therapeutic approach for the treatment of melanoma neoplasms. Nivolumab is an immunotherapeutic product that belongs to the so-called checkpoint inhibitors. Nivolumab therapy has demonstrated a good effect in terms of overall survival and progression-free survival in patients with malignant melanoma. Nivolumab treatment is used both for therapy in patients in the metastatic stage and in the adjuvant aspect in patients with a high risk of disease recurrence. The interaction between the ligand of the programmed cell death receptor (PD-L1) and the programmed cell death receptor (PD-1) leads to suppression of autoimmune manifestations. Blocking this interaction carries a risk of various autoimmune reactions, which are expressed to varying degrees, and can sometimes be life-threatening and require prolonged immunosuppression or discontinuation of treatment with checkpoint inhibitors. Immune-related adverse reactions of varying degrees and severity have been described with the use of anti-PD-1 antibodies, such as pneumonitis, hepatitis, endocrinopathies, immune-mediated colitis, dermatitis, etc. Rheumatic immune-mediated complications such as myositis, myalgia, arthritis, arthralgia, vasculitis, scleroderma are rare with Nivolumab treatment. Most often, patients report arthritis that starts after several cycles of Nivolumab administration. The mechanism of occurrence of immune-mediated arthritis has not yet been established. A clinical case of an 84-year-old patient who developed immune-related arthritis after treatment with Nivolumab is presented. After treatment with corticosteroids and immunosuppressants led to the control of the immune-related arthritis, reinitiation of immunotherapy is being evaluated for the management of the oncological disease.
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