CRAJ Winter 2024

Winter 2024 (Volume 34, Number 4)

Updates from CanRIO

By Shahin Jamal, MD, FRCPC, MSc

The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) is a network of rheumatologists and scientists from across Canada (see map) with an interest in improving the care of patients with rheumatic immune-related adverse effects (Rh-irAE) associated with cancer immunotherapy and patients with pre-existing rheumatic diseases (PRD) who are being considered for or receiving treatment with immunotherapy for cancer.

The idea to establish a Canadian collaboration in immuno-oncology was introduced in 2018. We had our inaugural meeting in 2018 where we defined our name, logo, objectives, mission, network and authorship agreements. Since then, CanRIO has become a globally recognized leader in patient care, research, education and advocacy for patients with Rh-irAE and those with PRD requiring cancer immunotherapy.

As we celebrate our five-year anniversary, we would like to reflect on our accomplishments and review our goals for the future. Since our inception, members of CanRIO have completed and published a national needs assessment and multiple review articles, which have guided our research agenda. We have established a national prospective cohort with clinical and biological data from over 300 patients and a national retrospective cohort with over 500 patients. The data from these two cohorts have been used to describe emerging rheumatic irAEs, and to evaluate the impact of patient and treatment factors on autoimmune and cancer outcomes.

In 2020, with the support of a CIORA grant, a website (www.canrio.ca) was created with interactive learning modules, clinician and patient resources, and a platform for connecting with the global community. Through the website, CanRIO has commenced successful quarterly international case rounds, attended by clinicians and researchers from around the world. In collaboration with the CRA Guidelines Committee, we have been actively working on a set of clinical practice guidelines, with a focus on management of immunotherapy in the context of PRD, de-novo inflammatory arthritis, de-novo myositis and de-novo sarcoid-like reactions. In 2023, CanRIO was awarded a second CIORA grant to conduct a proof-of-concept clinical trial evaluating adalimumab induction for de-novo inflammatory arthritis which is currently underway.

Looking to the future, we hope to continue our leadership role in this emerging area, both nationally and globally. We are collaborating with the Spanish Rheumatology Association to add 20 sites from Spain, and harmonizing data collection with sites in the USA, France, Germany and Australia. We would like to acknowledge the ongoing support we have received from the ARC, CRA, CIORA, our multiple industry partners, collaborators, colleagues and patients. Please continue referring patients to CanRIO sites. We would not be where we are without our entire community.

The CanRIO group at their most recent meeting in Toronto in May 2024.

Shahin Jamal, MD, FRCPC, MSc
Clinical Professor of Medicine, University of British Columbia
Clinician Investigator, Arthritis Research Canada
Co-Director, CanRIO Network
Vancouver, British Columbia

1. Maltez N, et al. Checking in with immune checkpoint inhibitors: Results of a needs assessment survey of Canadian rheumatologists. J Cancer Sci Therap. 2019.

2. Jamal S, Hudson M, Fifi-Mah A, et al. Immune-related Adverse Events Associated with Cancer Immunotherapy: A Review for the Practicing Rheumatologist. J Rheumatol. 2020 Feb;47(2):166-175. doi: 10.3899/jrheum.190084. Epub 2019 Jul 15. PMID: 31308203.

3. Ye C, Jamal S, Hudson M, et al. Immune Checkpoint Inhibitor Associated Rheumatic Adverse Events: A Review of Their Presentations and Treatments. Curr Treat Options in Rheum. 2019 (5):272-289.

4. Jamal S, Li J, Hudson M, Ye C. Management of Rheumatologic Immune-Related Adverse Events (Rh-irAEs) – An Overview of Immunosuppressive Therapies. Canadian Rheumatology Today. Spring 2024. 1(1): 34-39.

5. Roberts J, Ennis D, Hudson M, et al. Rheumatic immune-related adverse events associated with cancer immunotherapy: A nationwide multi-center cohort. Autoimmun Rev. 2020 Aug;19(8):102595. doi: 10.1016/j.autrev.2020.102595. Epub 2020 Jun 11. PMID: 32535092.

6. Hoa S, Laaouad L, Roberts J, et al. Preexisting autoimmune disease and immune-related adverse events associated with anti-PD-1 cancer immunotherapy: a national case series from the Canadian Research Group of Rheumatology in Immuno-Oncology. Cancer Immunol Immunother. 2021 Aug;70(8):2197-2207. doi: 10.1007/s00262-021-02851-5. Epub 2021 Jan 20. PMID: 33471137; PMCID: PMC10992076.