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CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1558964
This article is part of the Research Topic Immune Tolerance Dual Role: Advancements in Cancer and Autoimmune Diseases View all 7 articles
Case report: pembrolizumab in a patient with preexisting paraneoplastic dermatomyositis and sarcomatoid urothelial carcinoma. Searching for balance.
Provisionally accepted
Mariangela Torniai 1*
Giuseppe Pio Martino 2 Calogero Gucciardino 1 Stefano Angelici 2 Renato Bisonni 1- 1 UOC Oncologia, Ospedale Murri, Fermo, Italy
- 2 UOC Medicina Interna, Ospedale Murri, Fermo, Italy
Dermatomyositis (DM) is an uncommon systemic autoimmune disorder classified as one of the idiopathic inflammatory myopathies (IIM). DM could also represent a manifestation of an underlying neoplasm with a relative risk of cancer globally ranging from 3% to 8%. Owing to the strong connection between immunosurveillance and cancer progression, the management of paraneoplastic DM represents a challenging issue. To complicate matters is the advent of cancer immunotherapy, that might interfere with self-tolerance with a true risk of previous autoimmune disorders re-exacerbation. We report the case of a 50-year-old patient with advanced urothelial bladder cancer and preexisting paraneoplastic DM treated with pembrolizumab. On the basis of our experience, previous paraneoplastic DM might not necessarily represent an absolute contraindication for ICIs treatment. Furthermore, this case might suggest a role of intravenous immunoglobulins (IVIG) in preventing DM reactivation, underling the importance of a multidisciplinary approach.
Keywords: Immunotherapy, Paraneoplastic syndrome, autoimmune disease, Dermatomyositis, urothelial carcinoma, Pembrolizumab
Received: 11 Jan 2025; Accepted: 28 Feb 2025.
Copyright: © 2025 Torniai, Martino, Gucciardino, Angelici and Bisonni. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Mariangela Torniai, UOC Oncologia, Ospedale Murri, Fermo, Italy
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