How would you approach managing a patient with well-controlled RA on abatacept who develops a solid malignancy?

Ok- good question:

I would switch to an IL6inhibiton and let oncology do their thing.

Make sure they are on Plaquenil too. :)

Also, if the patient is going to get traditional chemo - watch and wait, likely the RA will be controlled with blanket immunosuppression of chemotherapy.

Petit et al., PMID 39241...

Great point: sit back and do nothing, sometimes freq steroids and chemo or transplant meds can control the RA for you.

I agree I have had to discontinue both orencia (which MOA is the antidote to immune checkpoint inhibitors) and Janus Kinase in favor of IL-6 Actemra or, depending on the type of can...