Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events
Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Patient Identification
2.2. Patient Classification
2.3. Musculoskeletal Ultrasound Evaluation
2.4. Statistical Analysis
3. Results
3.1. Demographic and Clinical Characteristics
3.2. Diagnosis and Ultrasound Findings
3.3. Therapeutic Changes Following Ultrasound
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Category | Variable | Value (Percentage) |
---|---|---|
Patients | Number of Patients | n = 23 |
Age | Median | 62 |
Sex | Male | 12 (52.2%) |
Female | 11 (47.8%) | |
Race | White | 20 (87%) |
Asian | 3 (13%) | |
Malignancy type | Melanoma | 11 (47.8%) |
RCC | 3 (13%) | |
Lung Cancers | 2 (8.7%) | |
Breast Cancers | 3 (13%) | |
Urothelial Carcinoma | 2 (8.7%) | |
Endometrial Carcinoma | 1 (4.3%) | |
Neuroendocrine carcinoma | 1 (4.3%) | |
ICI Type | PD-1 | 15 (65.2%) |
PDL-1 | 1 (4.3%) | |
PD-1 + CTLA-4 | 4 (17.4%) | |
PD-1 + LAG3 | 3 (13%) | |
Additional irAEs | Mean | 1.1 |
Median | 1 | |
Number of Patients with other irAEs | 11 (47.8%) | |
Number of Patients without other irAEs | 12 (52.2%) | |
Symptom Timing | On ICI | 15 (65.2%) |
Post-ICI | 8 (34.8%) | |
ICI Cycles prior to Symptoms | Mean | 7.7 |
Median | 7 | |
Duration of Time between Symptoms and MSKUS | Mean Months | 12.74 |
Median Months | 5 | |
MSKUS Timing in Relation to ICI | On ICI | 9 (39.1%) |
Post-ICI | 14 (60.9%) | |
MSK-irAE Therapy Initiation | On Therapy Prior to MSKUS | 17 (73.9%) |
No Therapy Prior to MSKUS | 6 (26.1%) | |
MSK-irAE Therapy at Time of MSKUS | On Therapy | 11 (47.8%) |
Not on Therapy | 12 (52.2%) | |
MSK-irAE Therapies Prior to MSKUS | Steroid (PO) | 17 (73.9%) |
CSI | 3 (13%) | |
csDMARD | 7 (30.4%) | |
Biologic | 2 (8.7%) | |
None | 6 (26.1%) | |
MSK-irAE Therapy Type at MSKUS | Steroid (PO) Monotherapy | 8 (34.8%) |
csDMARD + Steroid (PO) | 2 (8.7%) | |
Biologic | 1 (4.3%) | |
None | 12 (52.2%) | |
Final Diagnosis | MSK-irAE | 19 (82.6%) |
No MSK-irAE | 4 (17.4%) | |
Escalation in MSK-irAE Therapy Post-MSKUS | Therapy Escalation | 16 (69.6%) |
No Therapy Change | 7 (30.4%) | |
Additional Therapy Type (n = 16) | Steroid (PO) | 5 (31.3%) |
CSI | 7 (43.8%) | |
csDMARD | 7 (43.8%) | |
Biologic | 1 (6.3%%) | |
Patient Deciding | 1 (6.3%%) | |
Future MSK-irAE therapy Changes (in those with MSK-irAEs, n = 19) | Further Therapies | 4 (21.1%) |
No Further Therapies | 15 (78.9%) | |
Response to Therapy in those with MSK-irAEs (n = 19) | Resolved MSK-irAE | 5 (26.3%) |
Improved MSK-irAE | 9 (47.4%) | |
Too early to evaluate | 4 (21.1%) | |
Patient deceased prior to Evaluation | 1 (5.3%) | |
Follow-up from MSKUS in those with MSK-irAEs (months) | Median | 7 |
ICI Halted due to concern for MSK-irAE | Yes | 3 (13%) |
No | 20 (87%) | |
Changes in ICI Following MSKUS (for those on ICI at time of MSK-irAE, occurrence n = 15) | Halted | 2 (13.3%) |
Resumed | 1 (6.7%) | |
No Change | 12 (80%) |
Pt | Scoring | Location | Joint(s) | Bone | Tendon Involvement | Inflammatory Synovial Fluid (1: Yes; 2: No; -: No Fluid) | Final Diagnosis | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
GS | PD | Effusion | Erosions | TS | En | Enp | |||||
UW1 | 1 | Knee | 2 | - | + | - | - | - | - | 1 | MSK-irAE |
Ankle | 1 | - | + | - | - | - | - | - | |||
UW2 | 0 | Hand | 2 | 1 | - | + | - | - | - | - | Severe OA |
UW3 | 1 | Knee | 2 | - | + | - | - | - | - | 1 | MSK-irAE |
UW4 | 2 | Knee | 2 | 1 | + | - | - | + (patellar tendon) | - | - | MSK-irAE |
Ankle | 2 | 1 | + | - | + (posterior tibial tendon) | - | - | - | |||
UW5 | 2 | Knee | 2 | 2 | + | - | + (quadriceps tendon) | - | - | 1 | MSK-irAE |
UW6 | 0 | Knee | - | - | + | - | - | - | - | - | Non-inflammatory pain |
UW7 | 0 | Hand | 1 | - | - | - | - | - | - | - | MSK-irAE |
UW8 | 2 | Knee | 2 | - | + | - | - | - | - | - | MSK-irAE |
R Wrist | 1 | 1 | - | - | + (extensor tendons) | - | - | - | |||
L Wrist | - | 1 | - | - | - | - | - | - | |||
L 3rd MCP | - | 1 | - | - | - | - | - | - | |||
Ankle | 1 | - | + | - | - | - | - | - | |||
UW9 | 1 | Knee | 2 | - | + | - | - | - | - | 1 | MSK-irAE |
UW10 | 2 | Knee | 2 | 1 | + | - | - | - | - | 1 | MSK-irAE |
UW11 | 2 | R Wrist | 2 | 1 | - | + | - | + (extensor tendons) | - | - | MSK-irAE |
L Wrist | 2 | 2 | - | - | + (extensor tendons) | - | - | ||||
R 2nd MCP | 1 | - | - | - | - | - | - | ||||
L 2nd MCP | 1 | - | - | - | - | - | - | ||||
UW12 | 2 | Hand | - | 1 | - | - | - | + (DIP extensor tendon enthesitis) | - | - | MSK-irAE |
UW13 | 0 | Ankle | - | - | - | - | - | - | + | - | Non-inflammatory pain |
Foot | - | - | + | - | - | - | + | - | |||
UW14 | 1 | Shoulder | - | - | - | - | + (L biceps tendon) | - | - | - | MSK-irAE |
UW15 | 2 | Knee | 2 | 1 | + | - | - | - | - | - | MSK-irAE |
UW16 | 2 | Knee | - | - | - | + | - | + (quadriceps tendon enthesitis, patellar tendon enthesitis) | + | - | MSK-irAE |
Ankle | - | - | - | - | + (Achilles tendon enthesitis) | + | - | ||||
Foot | - | - | - | - | + (plantar aponeurosis enthesitis) | - | - | ||||
Elbow | - | - | - | - | + (triceps enthesitis) | + | - | ||||
UW17 | 2 | R Hand | 1 | 1 | + | + | + (2nd and 3rd MCP extensor tendons) | - | - | - | MSK-irAE |
L Hand | 1 | - | + | - | - | - | - | - | |||
UW18 | 2 | R Hand | 1 | 1 | - | - | - | - | - | - | MSK-irAE |
L Hand | 1 | 1 | - | - | - | - | - | - | |||
UW19 | 0 | Wrist | - | - | - | - | + (R extensor pollicis brevis and abductor pollicis longus) | - | - | - | MSK-irAE |
UW20 | 0 | Hand | 1 | - | - | - | - | - | - | - | Carpal Tunnel Syndrome |
UW21 | 2 | R Wrist | 2 | 1 | + | + | + (extensor tendons) | - | - | - | MSK-irAE |
L Wrist | 2 | 1 | + | + (extensor tendons) | - | - | - | ||||
UW22 | 2 | R Knee | 2 | 1 | + | - | - | - | - | 1 | MSK-irAE |
UW23 | 2 | Hand | 2 | 2 | + | - | - | - | - | - | MSK-irAE |
Pt | Anti-Inflammatory Therapy at Time of MSKUS | Past Treatments for MSK-irAEs | Change in MSK-irAE Therapy Following US? | Change | Additional MSK-irAE Treatments (Outside of Immediate Changes) |
---|---|---|---|---|---|
UW1 | None | None | Yes | CSI | Prednisone, Tocilizumab |
UW2 | None | Prednisone, MTX, HCQ | No | NA | NA |
UW3 | Prednisone, MTX | Prednisone | Yes | CSI, MTX increase | NA |
UW4 | Prednisone | Prednisone | Yes | Prednisone increase | NA |
UW5 | Prednisone | Prednisone | Yes | CSI, Prednisone increase | MTX |
UW6 | None | None | No | NA | Prednisone, HCQ, SSZ |
UW7 | None | Prednisone, SSZ | Yes | Remained off treatment | Prednisone, HCQ |
UW8 | Prednisone | Prednisone | Yes | MTX | NA |
UW9 | None | None | Yes | CSI | None |
UW10 | Prednisone | Prednisone, HCQ, CSIs, MTX, Tocilizumab | Yes | CSI | Tocilizumab, CSIs, Prednisone |
UW11 | None | None | Yes | Prednisone, MTX | None |
UW12 | None | None | Yes | Prednisone | None |
UW13 | None | Prednisone | No | NA | None |
UW14 | Prednisone | Prednisone | No | NA | None |
UW15 | Prednisone | Prednisone | Yes | MTX | None |
UW16 | Rituximab | Prednisone, MTX, Rituximab | Yes | Adalimumab | None |
UW17 | None | Prednisone | Yes | HCQ | None |
UW18 | Prednisone | Prednisone, MTX | No | NA | None |
UW19 | Prednisone, MTX | Prednisone, MTX | No | NA | None |
UW20 | None | None | No | NA | None |
UW21 | None | Prednisone, CSIs | Yes | CSI, prednisone, MTX | None |
UW22 | Prednisone | Prednisone, CSI | Yes | CSI, MTX | None |
UW23 | None | Prednisone | Yes | Deciding | None |
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von Eckstaedt, H.V.; Weng, K.; Sacksen, I.; Stovall, R.; Grivas, P.; Bhatia, S.; Hall, E.; Pollock, S.; Singh, N. Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events. Cancers 2025, 17, 2344. https://doi.org/10.3390/cancers17142344
von Eckstaedt HV, Weng K, Sacksen I, Stovall R, Grivas P, Bhatia S, Hall E, Pollock S, Singh N. Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events. Cancers. 2025; 17(14):2344. https://doi.org/10.3390/cancers17142344
Chicago/Turabian Stylevon Eckstaedt, Hans Vitzthum, Kevin Weng, Ingeborg Sacksen, Rachael Stovall, Petros Grivas, Shailender Bhatia, Evan Hall, Scott Pollock, and Namrata Singh. 2025. "Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events" Cancers 17, no. 14: 2344. https://doi.org/10.3390/cancers17142344
APA Stylevon Eckstaedt, H. V., Weng, K., Sacksen, I., Stovall, R., Grivas, P., Bhatia, S., Hall, E., Pollock, S., & Singh, N. (2025). Sonographic Signatures of Immune Checkpoint Inhibitor-Associated Musculoskeletal Adverse Events. Cancers, 17(14), 2344. https://doi.org/10.3390/cancers17142344