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CC BY 4.0 · Brazilian Journal of Oncology 2026; 22: s00451814174
DOI: 10.1055/s-0045-1814174
Original Article
Clinical Oncology

Rheumatic Immune-Related Adverse Events in Patients with Metastatic Melanoma: Insights for Treatment from a Single Cancer Center

Autor*innen

  • Surian Clarisse C. R. Ribeiro 

    1   Department of Rheumatology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

  • Guilherme G. M. Balbi 

    1   Department of Rheumatology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

  • Bruna G. Bunjes 

    1   Department of Rheumatology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

  • Milton Jose B. Silva 

    2   Department of Oncology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil

  • Danieli C. O. de Andrade 

    3   Department of Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

Funding The authors declare that they did not receive funding from agencies in the public, private or non-profit sectors to conduct the present study.
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Abstract

Introduction

Clinical trials that led to the Food and Drug Administration (FDA) approval of systemic cancer therapies have generally excluded patients with autoimmune disease (AID) due to concerns about increased immune-related adverse events (irAEs), disease flares, and potential reductions in the efficacy of immunotherapies.

Objective

To evaluate the optimal disease-modifying antirheumatic drug (DMARD) for patients with metastatic melanoma and immune-mediated rheumatic disease based on a narrative literature review and a case series from A.C.Camargo Cancer Center.

Materials and Methods

This retrospective study included 10 adults with disseminated melanoma and immune-mediated diseases who were treated at the Rheumatology Outpatient Clinic at A.C.Camargo Cancer Center in Brazil between January 2020 and September 2024. A narrative literature review was conducted utilizing the Scopus and PubMed databases.

Results

In this case series, 6 of the total 10 patients were treated with methotrexate (MTX), while those needing enhanced immunosuppression received tocilizumab due to its dual antitumor and anti-inflammatory properties. Furthermore, combining it with BRAF/MEK inhibitors effectively controlled inflammatory symptoms in the joints and skin. Clinical trials indicated that MTX and anti-IL-6 therapies are safe and effective in preventing and treating irAEs induced by immune checkpoint inhibitors (ICIs) and BRAF/MEK inhibitors. Previous case series suggest hydroxychloroquine and anti-IL-17 therapies may also be viable options. However, abatacept, sulfasalazine, and leflunomide should be avoided in patients receiving ICIs.

Conclusion

When selecting an appropriate DMARD, the potential synergistic or detrimental effects on tumor behavior, the patient's risk for adverse events, melanoma stage, and ongoing cancer treatment should all be considered. Individual cytokine profiles and specific immune cell types may direct future research for managing irAE. Additionally, the degree of immunosuppression experienced by a patient may significantly impact their prognosis and warrants further investigation.

Keywords

adverse drug events - immune checkpoint inhibitors - molecular targeted therapy - immunosuppressants - musculoskeletal system

Authors' Contributions

SR and MS: conceptualization, data curation, and writing; GB and BB: data curation; and DA: conceptualization and writing.




Publikationsverlauf

Eingereicht: 04. Juni 2025

Angenommen: 10. Oktober 2025

Artikel online veröffentlicht:
25. Januar 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil

Bibliographical Record
Surian Clarisse C. R. Ribeiro, Guilherme G. M. Balbi, Bruna G. Bunjes, Milton Jose B. Silva, Danieli C. O. de Andrade. Rheumatic Immune-Related Adverse Events in Patients with Metastatic Melanoma: Insights for Treatment from a Single Cancer Center. Brazilian Journal of Oncology 2026; 22: s00451814174.
DOI: 10.1055/s-0045-1814174
 

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