TNF in the era of immune checkpoint inhibitors: friend or foe?

Immune checkpoint inhibitors (ICIs) are effective in the treatment of patients with advanced cancer and have emerged as a pillar of standard cancer care. However, their use is complicated by adverse effects known as immune-related adverse events (irAEs), including ICI-induced inflammatory arthritis....

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Bibliographic Details
Published in:Nature reviews. Rheumatology Vol. 17; no. 4; pp. 213 - 223
Main Authors: Chen, Allen Y, Wolchok, Jedd D, Bass, Anne R
Format: Journal Article
Language:English
Published: United States Nature Publishing Group 01.04.2021
Subjects:
Adverse events
Arthritis
Arthritis - chemically induced
Arthritis - immunology
Cancer
Drug Interactions
Drug Synergism
Drug-Related Side Effects and Adverse Reactions - immunology
Glucocorticoids
Humans
Immune checkpoint inhibitors
Immune Checkpoint Inhibitors - adverse effects
Immune Checkpoint Inhibitors - therapeutic use
Immunotherapy - methods
Inflammation - chemically induced
Inflammation - drug therapy
Inflammatory bowel diseases
Intestine
Neoplasms - drug therapy
Neoplasms - immunology
Patients
Rheumatoid arthritis
Risk Assessment
Safety
Spondyloarthropathy
TNF inhibitors
Tumor necrosis factor
Tumor Necrosis Factor Inhibitors - adverse effects
Tumor Necrosis Factor Inhibitors - pharmacology
Tumor Necrosis Factor Inhibitors - therapeutic use
Tumor Necrosis Factor-alpha - immunology
ISSN:1759-4790, 1759-4804, 1759-4804
Online Access:Get full text
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Summary:Immune checkpoint inhibitors (ICIs) are effective in the treatment of patients with advanced cancer and have emerged as a pillar of standard cancer care. However, their use is complicated by adverse effects known as immune-related adverse events (irAEs), including ICI-induced inflammatory arthritis. ICI-induced inflammatory arthritis is distinguished from other irAEs by its persistence and requirement for long-term treatment. TNF inhibitors are commonly used to treat inflammatory diseases such as rheumatoid arthritis, spondyloarthropathies and inflammatory bowel disease, and have also been adopted as second-line agents to treat irAEs refractory to glucocorticoid treatment. Experiencing an irAE is associated with a better antitumour response after ICI treatment. However, whether TNF inhibition can be safely used to treat irAEs without promoting cancer progression, either by compromising ICI therapy efficacy or via another route, remains an open question. In this Review, we discuss clinical and preclinical studies that address the relationship between TNF, TNF inhibition and cancer. The bulk of the evidence suggests that at least short courses of TNF inhibitors are safe for the treatment of irAEs in patients with cancer undergoing ICI therapy. Data from preclinical studies hint that TNF inhibition might augment the antitumour effect of ICI therapy while simultaneously ameliorating irAEs.
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ISSN:1759-4790
1759-4804
1759-4804
DOI:10.1038/s41584-021-00584-4