Immune Checkpoint Inhibitor-induced Myositis.

Myositis induced by immune checkpoint inhibitors (ICIs) is an infrequent, potentially fatal, immune-related adverse event. It has higher incidence in patients who receive combination ICI therapy compared to monotherapy. Patients can present with clinical manifestation symptoms of myositis alone or in combination with myocarditis and/or myasthenia gravis, which significantly worsens the course and prognosis. Diagnosis can generally be made on the basis of clinical presentation, elevation of muscle enzymes, and electromyographic changes, but some patients may require a muscle biopsy. The first line of therapy is high-dose corticosteroids, followed by immunosuppression, plasmapheresis, or intravenous immunoglobulin in patients with severe disease.

Severe Lupus Enteritis Complicated by Intractable Gastrointestinal Hemorrhage.

Lupus enteritis (LE) is a rare presentation of systemic lupus erythematosus manifesting with nonspecific symptoms, laboratory derangements, and imaging findings. Rarely, LE may progress to bowel perforation, hemorrhage, and even death. Treatment with systemic glucocorticoids often results in rapid clinical improvement, but patients may require further immunosuppression. We present a case of severe LE complicated by life-threatening intractable gastrointestinal hemorrhage and warm autoimmune hemolytic anemia refractory to glucocorticoids and ultimately requiring massive transfusions, intravenous immunoglobulin, and plasmapheresis. This case illustrates the importance of early specialist involvement and treatment with intravenous immunoglobulin and plasmapheresis for severe, life-threatening LE.

Bone-Targeted Therapy Regimen and Skeletal-Related Events in Patients Surviving Longer Than 2 Years With Metastatic Breast Cancer and Bone Metastasis.

BACKGROUND: Bone-targeted therapy (BTT) including zoledronic acid (ZA) and denosumab decreases the risk of skeletal-related events (SREs) in patients with metastatic breast cancer (MBC) and bone metastasis. The impacts from prolonged BTT on SREs and BTT-associated harms are unknown and are becoming important to understand as these patients survive for longer periods. METHODS AND MATERIALS: We conducted a retrospective study of 224 patients with MBC and bone metastasis who survived for more than 2 years after diagnosis and received treatment at our institution between 2016 and 2021. We defined 3 BTT patterns: (1) ZA only, (2) denosumab only, (3) both ZA and denosumab. The association between these BTT patterns and SREs and harms was assessed using Fisher exact test and logistic regression. RESULTS: Rates of SREs overall were 21.2% of patients given ZA only, 8.8% of those given denosumab only, and 20% of those given both, without statistically significant differences (p = .32). However, those treated with denosumab only had significantly fewer compression fractures (0.7%) (p = .02). BTT-associated harm was observed in 5.8% of the ZA-only group, 11.7% of the denosumab-only group, and 14.3% of the group given both, without statistically significant differences (p = .37). CONCLUSION: Oncologists may have increased flexibility regarding the frequency of administration of BTT along with their choice of agent. Our study showed no significant difference in the prevention of overall SRE or development of BTT-associated harms between the BTT regimens evaluated.