Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?
I think the dermatomyositis could be more paraneoplastic that would actually benefit from controlling the cancer with ICI. I would give the treatment but I would carefully follow-up the patient for any irAEs. I will also document the rheumatological assessment, CPK, and myositis panel before startin...
It is always a balance of risks and benefits. If the checkpoint inhibitor has a good likelihood of extending the patient's life, I would proceed with careful serial monitoring. Situations like these call for a discussion between the oncologist, patient, and rheumatologist.
Agree with all the excellent answers already stated. As an oncologist, I would add that it depends on the underlying malignancy and treatment goals in the setting of the status of their dermatomyositis. I ask myself - what is the status of their dermatomyositis (or any autoimmune disorder), how many...
I agree with all that has been said - this is an important risk/benefit discussion. In addition, I would also screen for interstitial lung disease (consider PFTs to follow the patient, and Chest CT - fortunately many of these patients get CT chest evaluations for their cancer anyways). Agree with fo...
Would use with caution.