AB1021 CHARACTERISTICS AND MANAGEMENT OF RHEUMATIC MANIFESTATION UNDER ESTROGEN RECEPTOR-TARGETING CANCER THERAPIES, DATA FROM A PROSPECTIVE REGISTRY
Authors: A. Dr. Patroi, L. Diekmann, H.M. Lorenz, B. Kraemer, K. Benesova, J. Leipe
Journal: Annals of the Rheumatic Diseases (2020)

<h3>Background:</h3> The knowledge about interdependencies between rheumatic manifestations and malignancies is limited. Further, reliable data on the occurrence of rheumatic symptoms as side effects of specific cancer therapies beyond checkpointinhibitor-induced immune-related adverse events are sparse. In this regard, although arthralgia under estrogen receptor-targeting therapies (aromatase inhibitors and the estrogen receptor modulator tamoxifen) has been frequently reported in oncological clinical trials and case reports, prospective data including an assessment of rheumatic manifestations by rheumatologists are lacking. <h3>Objectives:</h3> To contribute to a better understanding of interdependencies between rheumatic manifestations and cancer/ estrogen blockade and potentially improve the management of both entities, pilot data were analysed. <h3>Methods:</h3> Data on characteristics and treatment of rheumatic manifestations and cancer as well as their timely association were systematically, prospectively collected and analysed in the MalheuR (´malignancy and rheumatic disease´) registry, a long-term, observational study designed to study patients suffering from concomitant rheumatic disease and malignancy and/or premalignant lesions. <h3>Results:</h3> We identified 11 patients with rheumatic manifestations under estrogen receptor-targeting therapies (3 anastrozol, 4 letrozol, 8 tamoxifen) as part of breast cancer treatment. In addition to breast cancer one patient had a lymphoma 3 years after and another patient had a non-small cell lung cancer 2 years before breast cancer diagnosis. The patients had different cancer stages (5 IA, 3 IIA, 1 IIB, and 1 IVA). Their mean age at cancer diagnosis was 60.4 ± 11.6 years and all patients are females. The time interval between diagnosis of cancer and onset of systemic/ rheumatic symptoms was 49.5 ± 34.0 months. Of interest, the time interval between onset of rheumatic symptoms and first assessment by a rheumatologist was 16.9 ± 22.3 months. The following systemic and rheumatic symptoms were reported: arthralgia in 10, arthritis in 8 (small joints in 5, large joints in 3 affected), morning stiffness (&gt;30 min) in 7, IBP in 1, myalgia in 7, sicca symptoms in 2, fever in 1 (new-onset FMF with heterozygous M694U mutation), class IV glomerulonephritis and polyserositis in 1 (with new-onset SLE) patient(s). Disease burden at baseline was rather high with a mean VAS pain of 65 (±12.9)/100. Laboratory analyses revealed an increased CRP in 6/11 (55%) with a mean of 10.3 ± 8.2 mg/l (&lt;5). Autoantibody positivity was observed for ANAs in 5/10 (50%, titers ranging from 1:80 to 1:160), anti-dsDNA in 1, rheumatoid factor in only 1/10 (10%) patients, none was anti-CCP positive. Before consulting a rheumatologist, patients were treated with NSAR 3/11 (27%), 10/11 systemic glucocorticoids (91%) with an initial dose of 17.5 ± 19.5 mg and intra-articular glucocorticoids 1/11 (9%). Rheumatological assessment lead to initiation of csDMARDs (3/11 MTX, 1/11 SSZ, 1/11 HCQ, 1/11 AZA (later MMF/ rituximab in the SLE patient) 1/11 colchicine) as corticosteroid-sparing agents with good response in the majority of patients. <h3>Conclusion:</h3> Our data demonstrate heterogeneous rheumatic manifestations, partially with severe manifestations beyond arthralgia, so far not reported by oncological studies including follow-up, which might suggest an underreporting. Furthermore, despite close monitoring in tumor aftercare, our data show a considerable delay in referral to a rheumatologist and initiation of suitable treatment. The prospective design of the MalheuR registry enables future validation of our pilot data. <h3>Disclosure of Interests:</h3> Alina Dr. Patroi Consultant of: Advisory board Novartis, Leonore Diekmann: None declared, Hanns-Martin Lorenz Grant/research support from: Consultancy and/or speaker fees and/or travel reimbursements: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly. Scientific support and/or educational seminars and/or clinical studies: Abbvie, MSD, BMS, Pfizer, Celgene, Medac, GSK, Roche, Chugai, Novartis, UCB, Janssen-Cilag, Astra-Zeneca, Lilly, Baxter, SOBI, Biogen, Actelion, Bayer Vital, Shire, Octapharm, Sanofi, Hexal, Mundipharm, Thermo Fisher., Consultant of: see above, Bernhard. Kraemer: None declared, Karolina Benesova Grant/research support from: Study grants for SCREENED study by Abbvie, Novartis and Rheumaliga Baden-Württemberg, Consultant of: One-time participation in Novartis advisory board., Jan Leipe Grant/research support from: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Consultant of: Consultancy and speaker fees: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB. Scientific support: Novartis, Pfizer., Speakers bureau: Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB