Checkpoint immunotherapy: good for cancer therapy, bad for rheumatic diseases

在Annals of Rheumatic Disease 裡面看到Checkpoint immunotherapy in cancer的文章。在這個immunotherapy正在開始萌芽的時候，有越來越多irAE被報導出來，這對rheumatologist來說似乎並不意外。
(在這個地方看到這篇文章真的有種他鄉遇故知的感覺.....)

"The study of knockout models reveals that absence of CTLA4 is associated with a highly lethal and rapidly progressive lymphoproliferative and autoimmune disorder."

"From a population health perspective, CTLA4 gene polymorphisms have been associated with an increased risk of numerous autoimmune diseases including rheumatoid arthritis."

"In regard to the PD-1 pathway, recent studies have demonstrated that CD8 T-cell exhaustion, a state characterised by increased PD-1 expression, is associated with a favourable outcome in autoimmune disease and thus it could be reasoned that loss of this state could exacerbate disease progression in individuals with concomitant autoimmunity."

未解的問題:
"The very important question of whether checkpoint therapy exacerbates
pre-existing autoimmunity is also poorly addressed....."

"with regard to therapy, we are also only at the beginning of understanding the optimal regimens and implications of adjunctive immunosuppression, in particular as to whether the presence of irAEs may augment or hinder the anti-tumour response."

最後登高一呼，在這個跨時代治療正在開始發展的時候，希望Rheumatologist多多幫助oncologist，畢竟在眾多專科之中風濕科的醫師是最靠近也最了解整個故事的人。

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