Combining immune-checkpoint inhibitors with tocilizumab to treat a lung adenocarcinoma patient with pre-existing polymyalgia rheumatica: A case report

Immune-checkpoint inhibitors (ICIs) have changed the management of advanced cancers. However, patients with pre-existing autoimmune diseases (ADs) have usually been excluded from clinical trials of ICIs due to concerns about exacerbation of AD. Here, we combined ICIs with selective immunosuppressant treatment in a metastatic lung adenocarcinoma patient with active pre-existing polymyalgia rheumatica (PMR). Remarkably, the strategy led to durable response and no exacerbation of PMR. Thus, we provide the first clinical evidence of treating metastatic cancer with ICIs and concomitant use of tocilizumab and hydroxychloroquine for active pre-existing PMR. We present a case in which a man with advanced NSCLC and active pre-existing PMR was treated with ICIs and concomitant TCZ. TCZ minimizes the risk of PMR flares and synergizes with ICIs, providing a win-win strategy.image