In this special episode of Around the Rheum, hosts Dr. Daniel Ennis and Dr. Janet Pope sit down with guideline co-authors Dr. Carrie Ye and Dr. Jeff Graham to break down the newly released Canadian Rheumatology Association/Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) Living Guidelines for the management of baseline immunosuppression in individuals with pre-existing rheumatic diseases initiating immune checkpoint inhibitors (ICIs).

Together, they unpack the key tensions clinicians face: balancing cancer treatment efficacy with the risk of flare of autoimmune disease, the challenges of low-quality and limited data, and the nuances of caring for patients whose autoimmune conditions behave very differently. From inflammatory arthritis to systemic autoimmune rheumatic diseases (SARDs), the panel highlights when to consider de-escalation, when to continue treatment, and how oncologists and rheumatologists can collaborate to support patient outcomes.

They also discuss what surprised them during the systematic review, what evidence is still missing — especially around oncologic outcomes — and how clinicians can access and stay update to date on these living guidelines.

A must-listen for anyone treating autoimmune disease or cancer in the era of immunotherapy!

Dr. Carrie Ye is a rheumatologist and Associate Professor at the University of Alberta. She practices at the Kaye Edmonton Clinic and runs a specialized Rheumatology & Immuno-Oncology Clinic, focusing on the intersection of autoimmune disease and cancer immunotherapy. Dr. Ye is a leading member of the CanRIO Research Group and a senior author of the new living guidelines discussed in this episode. 

Dr. Jeff Graham is a medical oncologist at CancerCare Manitoba and an Assistant Professor at the University of Manitoba. His clinical and research expertise focuses on genitourinary cancers, particularly kidney cancer and immunotherapy. He serves as the oncology lead on the CanRIO guideline team, bringing critical insight into cancer outcomes and treatment-risk balancing for patients receiving checkpoint inhibitors.

Around The Rheum is produced by the CRA Communications Committee. A special thank you to the podcast team, Dr. Dax G. Rumsey (CRA Communications Committee Chair), Dr. Daniel Ennis (Host), Dr. Janet Pope (Host) David McGuffin (exploreproductions.ca) and Erin Stewart (CRA) for leading production.

Our theme music was composed by Aaron Fontwell.

For more on the work of the Canadian Rheumatology Association, visit rheum.ca