Multidisciplinary effort facilitates care for ICI-related Sjogren's syndrome

A single-centre study has noted a 1.8-percent incidence of Sjogren's syndrome due to immune checkpoint inhibitors (ICIs). A multidisciplinary team including oncologists, dentists, and rheumatologists, among others, manages care for patients with this condition.

The authors described a series of four patients who developed Sjogren's syndrome during treatment with ICIs at a community cancer centre in Southern California, US, between 1 January 2017 and 31 December 2023. They obtained patient, drug, and disease-related data via retrospective chart review and searched PubMed to identify similar cases in the literature from 2016 to 2023.

The systematic review involved 80 cases in five articles. The male/female ratio was 1.5:1, and 9 percent of the patients had SS-A, SS-B, or antinuclear antibodies.

A total of 224 cancer patients at the institution received ICI treatment. Of these, four (1.8 percent, all male) developed Sjogren's syndrome. Among those with the condition, three received PD-1 inhibitors (nivolumab, pembrolizumab), and one received the PD-L1 inhibitor atezolizumab.

The median time to Sjogren's syndrome development was 24 weeks, with dry mouth symptoms being more prominent than dry eye symptoms. Of the patients, none had elevated SS-A, SS-B, or antinuclear antibodies, but one developed multiple tooth cavities and had extractions due to severe xerostomia. The incidence of xerostomia was double that of xerophthalmia.

Management of patients was symptomatic. Two cases of Sjogren's syndrome were irreversible, one was reversible, and a fourth was undermined as the patient was still on ICI therapy. Steroids had a limited role in management.

“Expanding the knowledge base pertaining to iatrogenic Sjogren's syndrome in patients on ICIs will be helpful in promoting early detection and treatment and improving outcomes,” the authors said.