Sicca/Sjögren's syndrome triggered by PD-1/PD-L1 checkpoint inhibitors. Data from the International Immunocancer Registry (ICIR)

ICIR, Manel Ramos-Casals, Peter Olsson, C Calabrese

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28 Citations (SciVal)


Objective. To analyse the worldwide occurrence of sicca/Sjögren's (SS) syndrome associated with the use of immune checkpoint inhibitors (ICI) in patients with cancer. Methods. The ImmunoCancer International Registry (ICIR) is a Big Data- Sharing multidisciplinary network composed by 40 specialists in Rheumatology, Internal Medicine, Immunology and Oncology from 18 countries focused on the clinical and basic research of the immune-related adverse events (irAEs) related to cancer immunotherapies. For this study, patients who were investigated for a clinical suspicion of SS after being exposed to ICI were included. Results. We identified 26 patients (11 women and 15 men, with a mean age at diagnosis of 63.57 years). Underlying cancer included lung (n=12), renal (n=7), melanoma (n=4), and other (n=3) neoplasia. Cancer immunotherapies consisted of monotherapy (77%) and combined regimens (23%). In those patients receiving monotherapy, all patients were treated with PD-1/PD-L1 inhibitors (nivolumab in 9, pembrolizumab in 7 and durvalumab in 4); no cases associated with CTLA-4 inhibitors were identified. The main SS-related features consisted of dry mouth in 25 (96%) patients, dry eye in 17 (65%), abnormal ocular tests in 10/16 (62%) and abnormal oral diagnostic tests in 12/14 (86%) patients. Minor salivary gland biopsy was carried out in 15 patients: histopathological findings consisted of mild chronic sialadenitis in 8 (53%) patients and focal lymphocytic sialadenitis in the remaining 7 (47%); a focus score was measured in 5 of the 6 patients (mean of 1.8, range 1-4). Immunological markers included positive ANA in 13/25 (52%), anti-Ro/ SS-A in 5/25 (20%), RF in 2/22 (9%), anti-La/SS-B in 2/25 (8%), low C3/C4 levels in 1/17 (6%) and positive cryoglobulins in 1/10 (10%). Classification criteria for SS were fulfilled by 10 (62%) out of 16 patients in whom the two key classificatory features were carried out. Among the 26 patients, there were only 3 (11%) who presented exclusively with sicca syndrome without organ-specific autoimmune manifestations. Therapeutic management included measures directed to treat sicca symptoms and therapies against autoimmune-mediated manifestations (glucocorticoids in 42%, second/ third-line therapies in 31%); therapeutic response for systemic features was observed in 8/11 (73%). No patient died due to autoimmune involvement. Conclusion. Patients with Sjögren's syndrome triggered by ICI display a very specific profile different from that reported in idiopathic primary SS, including more frequent occurrence in men, a higher mean age, a predominant immunonegative serological profile, and a notable development of organ-specific autoimmune involvement in spite of the poor immunological profile. The close association found between sicca/Sjögren's syndrome and primarily PD-1 blockade requires further specific investigation. © COPYRIGHT CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2019.
Original languageEnglish
Pages (from-to)S114-S122
JournalClinical and Experimental Rheumatology
Publication statusPublished - 2019

Subject classification (UKÄ)

  • Rheumatology and Autoimmunity
  • Cancer and Oncology


  • Durvalumab
  • Immune checkpoint inhibitors
  • Nivolumab
  • Pembrolizumab
  • Sjögren's syndrome
  • antinuclear antibody
  • cevimeline
  • cryoglobulin
  • cyclosporine
  • durvalumab
  • glucocorticoid
  • interleukin 10
  • ipilimumab
  • La antibody
  • methylprednisolone
  • nivolumab
  • pembrolizumab
  • pilocarpine
  • programmed death 1 ligand 1
  • programmed death 1 receptor
  • rheumatoid factor
  • Ro antibody
  • adult
  • aged
  • Article
  • autoimmune disease
  • cancer combination chemotherapy
  • cancer immunotherapy
  • cancer registry
  • chordoma
  • clinical article
  • colon cancer
  • dry eye
  • eye examination
  • female
  • histopathology
  • human
  • human tissue
  • kidney cancer
  • lung cancer
  • male
  • melanoma
  • middle aged
  • monotherapy
  • mouth examination
  • priority journal
  • retrospective study
  • salivary gland biopsy
  • sialoadenitis
  • Sjoegren syndrome
  • uterine cervix cancer
  • xerostomia
  • immunology
  • minor saliva gland
  • register
  • B7-H1 Antigen
  • Female
  • Humans
  • Male
  • Middle Aged
  • Programmed Cell Death 1 Receptor
  • Registries
  • Salivary Glands, Minor
  • Sjogren's Syndrome


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