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Kampoli K, Tsamis I, Sgouros D, Katsimbri P, Koumarianou A. Paraneoplastic dermatomyositis and Stevens-Johnson syndrome related to immunotherapy. Immunotherapy 2024:1-6. [PMID: 38888430 DOI: 10.1080/1750743x.2024.2362107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
Paraneoplastic syndromes such as dermatomyositis, often emerge as the initial clinical manifestation across various cancer types and are characterized by the development of B-cell responses targeting cancer-cell antigens that cross-react with normal skin and muscle cells. While these syndromes may alleviate following antineoplastic intervention, their response to immunotherapy remains elusive due to the exclusion of patients with autoimmune phenomena from clinical trials. In this report, we present the case of a female patient with advanced urothelial cancer presenting with dermatomyositis, who subsequently underwent treatment with anti-PD1 immunotherapy and experienced the onset of Stevens-Johnson syndrome. We discuss these two autoimmune entities and provide a comprehensive review of the existing literature to elucidate similar associations.
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Affiliation(s)
- Katerina Kampoli
- Hematology Oncology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
| | - Ioannis Tsamis
- Hematology Oncology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
| | - Dimitrios Sgouros
- 2nd Department of Dermatology & Venereology, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
| | - Pelagia Katsimbri
- Rheumatology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
| | - Anna Koumarianou
- Hematology Oncology Unit, 4th Department of Internal Medicine, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
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2
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Liu Y, Liu H, Bian Q, Guan Y. A 67-Year-Old Man with Grade 3 Reactive Cutaneous Capillary Endothelial Proliferation Induced by Camrelizumab First Manifested in the Oral Mucosa - A Case Report. Int J Surg Pathol 2024; 32:803-809. [PMID: 37723943 DOI: 10.1177/10668969231195032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Reactive cutaneous capillary endothelial proliferation (RCCEP) is the most common immune-related adverse event induced by camrelizumab (SHR-1210). Very rare cases have been reported in oral tissues, especially the oral mucosa. We reported a 67-year-old male with Grade 3 RCCEP. Multiple dome-shaped and bright red papules were first observed in the oral mucosa, which gradually developed on his lip, face, scalp, neck, foot, calf, abdomen and groin. The patient's symptoms gradually improved at 4 weeks after SHR-1210 discontinuation and were mostly relieved at 7 weeks after discontinuation. Our findings revealed that oral examination should be performed regularly during SHR-1210 treatment.
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Affiliation(s)
- Yong Liu
- Department of Dermatology & STD, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Hui Liu
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
| | - Queqiao Bian
- Department of Dermatology & STD, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yanmin Guan
- Department of Tuberculosis, Tianjin Haihe Hospital, Tianjin, China
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3
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Tolino E, Proietti I, Skroza N, Guardo AD, Fraia MD, Dybala A, Potenza C. Atopic Dermatitis Onset in a Melanoma Patient Under Pembrolizumab Therapy: A Case of Successful Treatment with Dupilumab. Indian J Dermatol 2024; 69:268-269. [PMID: 39119322 PMCID: PMC11305492 DOI: 10.4103/ijd.ijd_123_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Ersilia Tolino
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
| | - Ilaria Proietti
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
| | - Nevena Skroza
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
| | - Antonio Di Guardo
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
| | - Marco Di Fraia
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
| | - Agnieszka Dybala
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
| | - Concetta Potenza
- From the Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Fiorini Hospital, 04019 Terracina, Italy E-mail:
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4
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Chen ST, Semenov YR, Alloo A, Bach DQ, Betof Warner A, Bougrine A, Burton L, Cappelli LC, Castells M, Cohen J, Dewan AK, Fadden R, Guggina L, Hegde A, Huang V, Johnson DB, Kaffenberger B, Kroshinsky D, Kwatra S, Kwong B, Lacouture ME, Larocca C, Leventhal J, Markova A, McDunn J, Mooradian MJ, Naidoo J, Choi J, Nambudiri V, Nelson CA, Patel AB, Pimkina J, Rine J, Rubin KM, Sauder M, Shaigany S, Shariff A, Sullivan RJ, Zubiri L, Reynolds KL, LeBoeuf NR. Defining D-irAEs: consensus-based disease definitions for the diagnosis of dermatologic adverse events from immune checkpoint inhibitor therapy. J Immunother Cancer 2024; 12:e007675. [PMID: 38599660 PMCID: PMC11015215 DOI: 10.1136/jitc-2023-007675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 04/12/2024] Open
Abstract
With an increasing number of patients eligible for immune checkpoint inhibitors, the incidence of immune-related adverse events (irAEs) is on the rise. Dermatologic immune-related adverse events (D-irAEs) are the most common and earliest to manifest, often with important downstream consequences for the patient. Current guidelines lack clarity in terms of diagnostic criteria for D-irAEs. The goal of this project is to better define D-irAE for the purposes of identification, diagnosis, and future study of this important group of diseases.The objectives of this project were to develop consensus guidance for an approach to D-irAEs including disease definitions and severity grading. Knowing that consensus among oncologists, dermatologists, and irAE subspecialists would be critical for usability, we formed a Dermatologic irAE Disease Definition Panel. The panel was composed of 34 experts, including oncologists, dermatologists, a rheumatologist, and an allergist/immunologist from 22 institutions across the USA and internationally. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two virtual meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness, and accuracy on 9-point scales in electronic surveys and provided free text comments. A working group aggregated survey responses and incorporated them into revised definitions. Consensus was based on numeric ratings using the RAND/UCLA Appropriateness Method with prespecified definitions.Following revisions based on panelist feedback, all items received consensus in the second round of ratings. Consensus definitions were achieved for 10 core D-irAE diagnoses: ICI-vitiligo, ICI-lichen planus, ICI-psoriasis, ICI-exanthem, ICI-bullous pemphigoid, ICI-Grover's, ICI-eczematous, ICI-eruptive atypical squamous proliferation, ICI-pruritus without rash, and ICI-erosive mucocutaneous. A standard evaluation for D-irAE was also found to reach consensus, with disease-specific exceptions detailed when necessary. Each disorder's description includes further details on disease subtypes, symptoms, supportive exam findings, and three levels of diagnostic certainty (definite, probable, and possible).These consensus-driven disease definitions standardize D-irAE classification in a useable framework for multiple disciplines and will be the foundation for future work. Given consensus on their accuracy and usability from a representative panel group, we anticipate that they can be used broadly across clinical and research settings.
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Affiliation(s)
- Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Allireza Alloo
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Daniel Q Bach
- Department of Dermatology, Cedars Sinai, Los Angeles, California, USA
| | | | - Amina Bougrine
- Department of Dermatology, Université de Montréal, Montreal, Quebec, Canada
| | | | - Laura C Cappelli
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mariana Castells
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Justine Cohen
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Oncology, Centers for Cutaneous and Melanoma Oncology, Dana-Farber Cancer Insititute, Boston, MA, USA
| | - Anna K Dewan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Lauren Guggina
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Victor Huang
- Department of Dermatology, University of California Davis, Davis, California, USA
| | | | - Benjamin Kaffenberger
- Department of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shawn Kwatra
- Johns Hopkins Department of Dermatology, Baltimore, Maryland, USA
| | - Bernice Kwong
- Stanford University School of Medicine, Stanford, UK
| | - Mario E Lacouture
- MSKCC, New York, New York, USA
- NYU Langone Health, New York, New York, USA
| | - Cecilia Larocca
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jonathan Leventhal
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jon McDunn
- Project Data Sphere ®, Morrisville, North Carolina, USA
| | - Meghan J Mooradian
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jarushka Naidoo
- Johns Hopkins University, The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, Maryland, USA
| | - Jennifer Choi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinod Nambudiri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anisha B Patel
- Department of Dermatology, Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julia Pimkina
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Maxwell Sauder
- DIvision of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sheila Shaigany
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Afreen Shariff
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Ryan J Sullivan
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leyre Zubiri
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Mass General Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicole R LeBoeuf
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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5
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Khorasanchi A, Korman AM, Manne A, Meara A. Immune checkpoint inhibitor-induced subacute cutaneous lupus erythematosus: a case report and review of the literature. Front Med (Lausanne) 2024; 11:1334718. [PMID: 38362536 PMCID: PMC10867168 DOI: 10.3389/fmed.2024.1334718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024] Open
Abstract
Immune checkpoint inhibitor (ICI) use has been associated with numerous autoimmune side effects, known as immune related adverse events (irAEs). Cutaneous irAEs are common and affect up to 50% of patients treated with ICIs. There have been an increasing number of cases reported in the literature regarding ICI-induced subacute cutaneous lupus erythematosus (SCLE). ICI-induced SCLE is important to recognize as it can result in a delayed and/or prolonged skin reaction despite treatment discontinuation. We describe a patient with gastro-esophageal adenocarcinoma who developed SCLE following one cycle of nivolumab treatment. A 75-year-old man presented to our clinic with a new photo-distributed rash composed of oval scaly pink papules and plaques involving his chest and arms. Despite treatment with topical corticosteroids, he presented to the emergency department 1 week later with worsening rash. Skin biopsy showed vacuolar interface pattern, along with superficial perivascular lymphocytic infiltrate, consistent with a drug eruption. The clinicopathological presentation was consistent with ICI-induced SCLE. Nivolumab treatment was discontinued due to the severity of the rash. The rash remitted with systemic corticosteroids, high potency topical steroids, and hydroxychloroquine. Unfortunately, the patient developed intraperitoneal metastatic disease, and was enrolled in hospice care. In this paper, we highlight the importance of early identification and treatment of this irAE. A review of the literature, including a discussion on the management of ICI-induced SCLE is also provided.
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Affiliation(s)
- Adam Khorasanchi
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Abraham M. Korman
- Department of Dermatology, The Ohio State University, Columbus, OH, United States
| | - Ashish Manne
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Alexa Meara
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
- Division of Rheumatology and Immunology, The Ohio State University, Columbus, OH, United States
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Suzuki T. Diagnosing Beyond Bias: Differentiating Topical Steroid Withdrawal Syndrome From irAE-Induced Adrenal Insufficiency. Cureus 2023; 15:e50272. [PMID: 38196444 PMCID: PMC10774836 DOI: 10.7759/cureus.50272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Confirmation bias can impede accurate diagnosis. Since the approval of immune checkpoint inhibitors (ICIs), physicians are on high alert for newly developed immune-related adverse events (irAEs). Therefore, when patients present irAE-like symptoms, there is a risk of confirmation bias leading to overlooked diagnoses. This paper discusses a case of a patient with non-small cell lung cancer treated with nivolumab and topical dexamethasone ointment for an extended period due to oral mucocutaneous irAE. The patient developed adrenal insufficiency, initially considered to be a likely case of pituitary irAE. However, further investigation and the patient's clinical course revealed an unexpected diagnosis more in line with topical steroid withdrawal syndrome.
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Affiliation(s)
- Toshio Suzuki
- Department of Medical Oncology, University of Tsukuba, Tsukuba, JPN
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7
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Ghani H, Khan S, Jamgochian M, Richards B, DeCecco E, Fliorent R, Cheendalla N, Khatri K, Rao B. Cutaneous adverse effects associated with LAG-3 inhibitor use in cancer treatment: A systematic review. SKIN HEALTH AND DISEASE 2023; 3:e296. [PMID: 38047262 PMCID: PMC10690694 DOI: 10.1002/ski2.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/05/2023]
Abstract
Immunotherapy has become a mainstay of treatment for many cancers. Multiple immune checkpoint inhibitors have been used to treat malignancies, including anti-programed death-1 (PD1) and anti-cytotoxic T-lymphocyte-associated protein (anti-CTLA4). However, a significant percentage of patients develop resistance to these immunotherapy drugs. Therefore, novel strategies were developed to target other aspects of the immune response. Lymphocyte activation gene-3 (LAG-3) is a cell-surface molecule found on natural killer cells and activated T-cells which negatively regulates T-cell proliferation and function. LAG-3 inhibitors interact with LAG-3 ligands on the surface of T-cells to block T-regulatory (Treg) cell activity, suppress cytokine secretion and restore dysfunctional effector T-cells which subsequently attack and destroy cancer cells. This review reports the dermatologic side effects associated with LAG-3 inhibitors used in the treatment of melanomas. Using PRISMA 2022 guidelines, a comprehensive literature review of PubMed, Google Scholar, Embase, Cochrane, and Web of Science databases was conducted. Three studies were identified that demonstrated that the use of LAG-3 inhibitors, whether as a single agent or in combination with other immune checkpoint inhibitors, resulted in stomatitis, pruritus, rash, dry skin, erythema, and vitiligo. Further research is warranted to assess the cutaneous adverse events observed with LAG-3 inhibitors in treating melanoma and to identify populations most vulnerable to such side effects.
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Affiliation(s)
- Hira Ghani
- Nassau University Medical CenterEast MeadowNew YorkUSA
| | - Samavia Khan
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
| | - Marielle Jamgochian
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
| | - Beth Richards
- Cooper Medical School of Rowan UniversityCamdenNew JerseyUSA
| | - Erica DeCecco
- Cooper Medical School of Rowan UniversityCamdenNew JerseyUSA
| | - Rebecca Fliorent
- Rowan‐Virtua School of Osteopathic MedicineStratfordNew JerseyUSA
| | | | - Khalil Khatri
- Skin and Laser Surgery Center of New EnglandNashuaNew HampshireUSA
| | - Babar Rao
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
- Department of DermatologyWeill Cornell MedicineNew YorkNew YorkUSA
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8
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Shi X, Wang Y, Ren J, Han X, Bi Y. A retrospective pilot study of transarterial chemoembolisation using camrelizumab-eluting Callisphere beads for unresectable hepatocellular carcinoma. BMC Cancer 2023; 23:1144. [PMID: 38001447 PMCID: PMC10675937 DOI: 10.1186/s12885-023-11668-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/23/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Our objective was to assess the efficacy and safety of initial hepatic arterial infusion of chemotherapy combined with transarterial chemoembolisation using camrelizumab-eluting Callisphere beads (camrelizumab-DEB-TACE) for treating unresectable hepatocellular carcinoma (HCC). METHODS Enrolment included patients with unresectable HCC who underwent camrelizumab-DEB-TACE treatment from September 2021 to February 2023. The assessment included the examination of tumour response, overall survival (OS), progression-free survival (PFS), and the monitoring of adverse events (AEs). RESULTS Twenty-one patients were included in the study. The objective response rates (ORR) and disease control rates (DCR) were 55.0% and 90.0% at 1 month and 57.9% and 78.9% at 3 months, respectively. The median PFS and OS were 7.4 and 15.5 months months, respectively. Among the 21 patients, 4 underwent more than 2 procedures of camrelizumab-DEB-TACE, with a mean of 1.9 ± 1.1 procedures (range: 1-4) per patient. No severe complications or treatment-related mortalities were observed. In addition, no patient developed severe AEs related to camrelizumab, such as reactive cutaneous capillary endothelial proliferation, immune-related pneumonia, or immune-related myocarditis. Nineteen patients experienced at least one type of AEs related to DEB-TACE, with abdominal pain (n = 16, 76.2%) being the most prevalent AE. CONCLUSION Camrelizumab-DEB-TACE demonstrated effectiveness and safety as a treatment for unresectable HCC, with no occurrence of severe camrelizumab-related AEs.
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Affiliation(s)
- Xiaonan Shi
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Zhengzhou, China
| | - Yang Wang
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yonghua Bi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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9
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Pham JP, Wark KJL, Woods J, Frew JW. Resident cutaneous memory T cells: a clinical review of their role in chronic inflammatory dermatoses and potential as therapeutic targets. Br J Dermatol 2023; 189:656-663. [PMID: 37603832 DOI: 10.1093/bjd/ljad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Resident memory T cells (T-RMs) remain in epithelial barrier tissues after antigen exposure and the initial effector phase. These T-RMs provide effective antimicrobial and anticancer immunity; however, pathogenic T-RMs have been shown to mediate various chronic inflammatory disorders in a variety of tissue types. In the skin, T-RMs are referred to as resident cutaneous memory T cells (cT-RMs). Understanding the mechanisms leading to the development and establishment of these cT-RMs populations may allow for targeted treatments that provide durable responses in chronic immune-mediated skin diseases, even after cessation. In this review, we summarize the evidence on cT-RMs as drivers of chronic inflammatory dermatoses, including psoriasis, vitiligo, atopic dermatitis, cutaneous lupus erythematosus and alopecia areata, among others. Data from in vitro, animal model and ex vivo human studies are presented, with a focus on the potential for cT-RMs to trigger acute disease flares, as well as recurrent disease, by establishing an immune 'memory' in the skin. Furthermore, the available data on the potential for existing and novel treatments to affect the development or survival of cT-RMs in the skin are synthesized. The data suggest a dynamic and rapidly growing area in the field of dermatology; however, we also discuss areas in need of greater research to allow for optimal treatment selection for long-term disease control.
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Affiliation(s)
- James P Pham
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Kirsty J L Wark
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jane Woods
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - John W Frew
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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10
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Chen Y, Hong H, Bao S, Tang H. Stevens-Johnson syndrome induced by toripalimab in a previously EGFR-TKI-treated advanced lung adenocarcinoma patient harboring EGFR mutations 19 del/T790M/C797S in trans and cis: a case report. Front Pharmacol 2023; 14:1131703. [PMID: 38035001 PMCID: PMC10682071 DOI: 10.3389/fphar.2023.1131703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background: The treatment paradigm for advanced non-small-cell lung cancer (NSCLC) is rapidly changing. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and anti-programmed death-1 (PD-1) antibodies have increasingly been incorporated into routine care for nearly all patients with NSCLC. Toripalimab was recently approved as the first-line treatment for advanced non-squamous NSCLC in combination with chemotherapy. Stevens-Johnson syndrome (SJS) is a rare but potentially fatal complication of TKI and anti-PD-1 therapy. We reported a case of SJS after sequential use of EGFR-TKIs and toripalimab in an NSCLC patient with EGFR mutations 19 del/T790M/C797S in trans and cis. Case presentation: A 58-year-old man with stage IV NSCLC received gefitinib because next-generation sequencing (NGS) revealed an EGFR 19del, followed by osimertinib and pemetrexed with the emergence of EGFR T790M. Four EGFR mutations 19 del/T790M/C797S in trans and cis were detected after osimertinib resistance. The combination of toripalimab and docetaxel was administered as a third-line treatment. The patient developed SJS at 21 days, and toripalimab was discontinued. After treatment with methylprednisolone and prednisolone, the skin toxicity of the patient gradually decreased and eventually disappeared. The patient received osimertinib and anlotinib after recovery, and SJS has not recurred. The ongoing treatment is still effective and results in stable disease. Conclusion: We reported the first case of SJS induced by toripalimab in a patient with lung adenocarcinoma harboring multiple EGFR mutations. The TKI treatment after SJS was well tolerated and effective.
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Affiliation(s)
| | | | | | - Hao Tang
- Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
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11
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Martel J, Hanania HL, Patel AB. Immune checkpoint inhibitor-induced cutaneous toxicities: a review of histopathologic and clinical features. Hum Pathol 2023; 140:144-172. [PMID: 37141978 DOI: 10.1016/j.humpath.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) represent an emerging treatment option for a variety of cancer types. Through inhibition of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and/or cytotoxic lymphocyte-associated antigen-4 (CTLA-4), ICIs activate the host's immune system causing a heightened anti-tumor response. However, off-target effects of ICIs can result in numerous different immune-related cutaneous adverse events (irCAEs). Beyond impacting quality of life, irCAEs can lead to dose limitations or discontinuation of anti-cancer therapies. Correct diagnosis is necessary for expedient and appropriate management. Skin biopsies are often performed to increase diagnostic accuracy and guide clinical management. An extensive literature review was performed using the PubMed database to identify the reported clinical and histopathologic features of irCAEs. This comprehensive review primarily details the histopathologic features of various irCAEs reported to date. Clinical presentation and immunopathogenesis are also discussed in relation to histopathology.
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Affiliation(s)
- Julianna Martel
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Anisha B Patel
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA.
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12
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Plachouri KM, Florou V, Georgiou V, Georgiou S. Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies. Cancers (Basel) 2023; 15:3126. [PMID: 37370736 DOI: 10.3390/cancers15123126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The advent of immunotherapy and targeted therapies in treating dermatological malignancies has dramatically changed the landscape of dermato-oncology in recent years. Their superior efficacy compared to previous therapeutic options, such as chemotherapy, has resulted in their use in treating devastating malignancies, such as melanoma or unresectable/metastatic basal cell and squamous cell carcinoma. Skin toxicity is a critical safety consideration, among other adverse reactions, that can occur under treatment with these agents. This article aims to summarize the cutaneous side effects of immune checkpoint inhibitors and targeted dermato-oncological therapies. Although the skin side effects of these agents are primarily mild, they can occasionally affect the decision for treatment continuation and the quality of life of the affected patients. Therefore, physicians must be acquainted with the specific cutaneous toxicity profile of such treatments to mitigate their impact on the patients and optimize the overall outcome of dermato-oncological therapy.
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Affiliation(s)
- Kerasia-Maria Plachouri
- Dermatology Department, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
| | - Vaia Florou
- Division of Oncology, Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 841112, USA
| | - Vasileios Georgiou
- School of Medicine, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
| | - Sophia Georgiou
- Dermatology Department, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
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13
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Liu SS, Howard T, Fattah YH, Adams A, Hanly AJ, Karai LJ. Lichen Planopilaris Pemphigoides: A Novel Bullous Dermatosis Due to Programmed Cell Death Protein-1 Inhibitor Therapy. Am J Dermatopathol 2023; 45:246-249. [PMID: 36825932 PMCID: PMC10018802 DOI: 10.1097/dad.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Lichen planus pemphigoides (LPPemph), apart from bullous pemphigoid, is a rare bullous dermatosis that can be induced by programmed cell death protein-1 (PD-1)/PD ligand 1 (PD-L1) inhibitors. The primary location of PD-1/PD-L1 inhibitor-induced LPPemph has previously only been reported at the nonfollicular dermal-epidermal junction. We present a case of nivolumab-induced LPPemph with an intense perifollicular lichenoid reaction, prominent multifocal perifollicular clefting, which in addition, was also accompanied by linear IgG and C3 immunofluorescence deposits along the dermal-epidermal junction as well as demonstrating a perifollicular pattern. Intriguingly, the serological study of BP180 and BP230 antibodies was negative, suggesting the presence of additional novel antibodies, which primarily favor hair follicles and may contribute to the pathogenesis. Therefore, we consider this entity a novel variant of PD-1/PD-L1 inhibitor-induced bullous dermatosis. To the best of our knowledge, this is the first report that highlights perifollicular bullae accompanied by immunofluorescence findings in a PD-1/PD-L1 inhibitor-induced lesion. We propose a new immunotherapy associated entity, lichen planopilaris pemphigoides, and emphasize the significance of perifollicular changes in the pathogenesis.
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Affiliation(s)
- Shuo S. Liu
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Tara Howard
- University of Miami, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Yasmin H. Fattah
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Amy Adams
- South Central Dermatology Clinic, Laurel, MS; and
| | | | - Laszlo J. Karai
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Global Pathology, Sonic Healthcare USA, Miami Lakes, FL
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14
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Nikolaou V, Tsimpidakis A, Stratigos A. Cutaneous Adverse Reactions of Immunotherapy in Patients with Advanced Melanoma. Cancers (Basel) 2023; 15:cancers15072084. [PMID: 37046745 PMCID: PMC10093334 DOI: 10.3390/cancers15072084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Immune checkpoint blockers (ICBs) have been widely used during the last decade for the treatment of various tumors, including advanced and metastatic melanoma. While these agents have improved melanoma patients’ survival rates, they have also been associated with various autoimmune toxicities, with the skin being most commonly affected. The severity of cutaneous toxicity can not only negatively affect patients’ quality of life but can also limit the proper treatment of cancer. Thus, the role of the dermatologist is substantial in early detecting and promptly treating these adverse events. Maculopapular rash, psoriasiform, lichenoid dermatoses and bullous pemphigoid are the most frequent cutaneous adverse events that require immediate intervention. Other rare autoimmune toxicities, e.g., sarcoidosis, dermatomyositis or subacute lupus, have also been reported. In this review, we summarize the aspects of ICB-induced cutaneous toxicities in patients with melanoma, emphasizing their management and treatment options in clinical practice.
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15
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Zheng C, Shi Y, Zou Y. T cell co-stimulatory and co-inhibitory pathways in atopic dermatitis. Front Immunol 2023; 14:1081999. [PMID: 36993982 PMCID: PMC10040887 DOI: 10.3389/fimmu.2023.1081999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
The use of immune checkpoint inhibitors (ICIs) targeting the T cell inhibitory pathways has revolutionized cancer treatment. However, ICIs might induce progressive atopic dermatitis (AD) by affecting T cell reactivation. The critical role of T cells in AD pathogenesis is widely known. T cell co-signaling pathways regulate T cell activation, where co-signaling molecules are essential for determining the magnitude of the T cell response to antigens. Given the increasing use of ICIs in cancer treatment, a timely overview of the role of T cell co-signaling molecules in AD is required. In this review, we emphasize the importance of these molecules involved in AD pathogenesis. We also discuss the potential of targeting T cell co-signaling pathways to treat AD and present the unresolved issues and existing limitations. A better understanding of the T cell co-signaling pathways would aid investigation of the mechanism, prognosis evaluation, and treatment of AD.
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Affiliation(s)
- Chunjiao Zheng
- Skin and Cosmetic Research Department, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuling Shi
- Institute of Psoriasis, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Yuling Shi, ; Ying Zou,
| | - Ying Zou
- Skin and Cosmetic Research Department, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Yuling Shi, ; Ying Zou,
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16
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Maul JT, Guillet C, Oschmann A, Maul LV, Meier-Schiesser B, Stadler PC, French LE, Kerl K. Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications. J Eur Acad Dermatol Venereol 2023; 37:965-975. [PMID: 36652271 DOI: 10.1111/jdv.18879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords 'lichenoid drug rash' and 'lichenoid drug eruption' were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti-TNF-α-monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1-208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71-416 weeks). One hundred thirty-six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.
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Affiliation(s)
- Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anna Oschmann
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Pia-Charlotte Stadler
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katrin Kerl
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
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17
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Watanabe T, Yamaguchi Y. Cutaneous manifestations associated with immune checkpoint inhibitors. Front Immunol 2023; 14:1071983. [PMID: 36891313 PMCID: PMC9986601 DOI: 10.3389/fimmu.2023.1071983] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that block key mediators of tumor-mediated immune evasion. The frequency of its use has increased rapidly and has extended to numerous cancers. ICIs target immune checkpoint molecules, such as programmed cell death protein 1 (PD-1), PD ligand 1 (PD-L1), and T cell activation, including cytotoxic T-lymphocyte-associated protein-4 (CTLA-4). However, ICI-driven alterations in the immune system can induce various immune-related adverse events (irAEs) that affect multiple organs. Among these, cutaneous irAEs are the most common and often the first to develop. Skin manifestations are characterized by a wide range of phenotypes, including maculopapular rash, psoriasiform eruption, lichen planus-like eruption, pruritus, vitiligo-like depigmentation, bullous diseases, alopecia, and Stevens-Johnson syndrome/toxic epidermal necrolysis. In terms of pathogenesis, the mechanism of cutaneous irAEs remains unclear. Still, several hypotheses have been proposed, including activation of T cells against common antigens in normal tissues and tumor cells, increased release of proinflammatory cytokines associated with immune-related effects in specific tissues/organs, association with specific human leukocyte antigen variants and organ-specific irAEs, and acceleration of concurrent medication-induced drug eruptions. Based on recent literature, this review provides an overview of each ICI-induced skin manifestation and epidemiology and focuses on the mechanisms underlying cutaneous irAEs.
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Affiliation(s)
- Tomoya Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
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18
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Mueller KA, Cordisco MR, Scott GA, Plovanich ME. A case of severe nivolumab-induced lichen planus pemphigoides in a child with metastatic spitzoid melanoma. Pediatr Dermatol 2023; 40:154-156. [PMID: 35882548 DOI: 10.1111/pde.15097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/09/2022] [Indexed: 01/25/2023]
Abstract
Dermatologic reactions are among the most common adverse events of antiprogrammed cell death-1 (anti-PD-1) monoclonal antibodies agents and include maculopapular rash, psoriasiform rash, lichenoid eruptions, autoimmune bullous disorders, and vitiligo. Here, we present a case of a 12-year-old African American male with metastatic spitzoid melanoma treated with nivolumab who developed a mild lichenoid eruption that progressed to a severe case of lichen planus pemphigoides (LPP). Management was complex given the patient's age and history and included hospitalization for intravenous steroids, an intensive topical steroid regimen, methotrexate, and discontinuation of nivolumab. This case illustrates a rare but dramatic progression from a mild LP-like eruption to severe bullous lichenoid eruption, most consistent with LPP, as well as the diagnostic and treatment challenges in the setting of a pediatric patient on nivolumab.
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Affiliation(s)
- Kelly A Mueller
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Maria R Cordisco
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Glynis A Scott
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Molly E Plovanich
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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19
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Ahmad M, Murphy MJ, Damsky W, Leventhal J. Dupilumab‐induced psoriasis in the setting of pembrolizumab therapy: an analysis of cytokine expression. Int J Dermatol 2022. [DOI: 10.1111/ijd.16538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Maham Ahmad
- Department of Dermatology Yale University School of Medicine New Haven CT USA
| | - Michael J. Murphy
- Department of Dermatology Yale University School of Medicine New Haven CT USA
| | - William Damsky
- Department of Dermatology Yale University School of Medicine New Haven CT USA
- Department of Pathology Yale University School of Medicine New Haven CT USA
| | - Jonathan Leventhal
- Department of Dermatology Yale University School of Medicine New Haven CT USA
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20
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Reddy R, Park A, Vandergriff T, Chong BF. Concomitant nondermatologic adverse events in patients who develop immunotherapy-induced subacute cutaneous lupus erythematosus. Dermatol Ther 2022; 35:e15906. [PMID: 36200592 DOI: 10.1111/dth.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rasika Reddy
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Park
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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21
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To treat or not to treat: PD-L1 inhibitor-induced keratoacanthoma and squamous cell carcinoma. Arch Dermatol Res 2022; 315:903-915. [PMID: 36394634 DOI: 10.1007/s00403-022-02468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Keratoacanthoma (KA) and squamous cell carcinoma (SCC) are rare side effects of programmed cell death ligand-1 (PD-L1) inhibitors that can disrupt therapy. There is no consensus on optimal treatment. We investigated the management strategy and factors influencing pathophysiology. An institutional cancer registry and literature search were used for this retrospective study. Only PD-L1-induced KA and SCC cases were included. Pathology specimens were stained with immune markers and management strategies were analyzed. Four cases were identified at our institution. Immunohistochemistry of atypical keratinocytes revealed PD-1/PD-L1 positivity, high p53, and low bcl-2 for all cases with differential expression of CD44 and beta-catenin for KA versus SCC. Nivolumab was continued or temporarily held with complete resolution. In addition, a literature search identified 30 additional cases of KA/SCC after PDL-1 inhibitor use. The most common treatment was excision/destruction followed by topical and/or intralesional corticosteroids. Therapy was definitely withheld in 22% of KA patients and in 9% of SCC cases. The expression of PD-L1 by atypical keratinocytes helps to explain the effects of nivolumab on the development of cutaneous neoplasms. The expression of immune markers provides mechanistic insights into pathophysiology. Management may be achieved with conservative therapy and without treatment interruption.
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22
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Lambert WC, Shah RR, Lambert MW, Schwartz RA. Occult squamous cell carcinoma within lichenoid dermatitis: three examples of cryptic cancer detection. Arch Dermatol Res 2022; 315:795-798. [PMID: 36316509 DOI: 10.1007/s00403-022-02436-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 08/22/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022]
Abstract
Lichenoid dermatitis can be a perplexing entity encompassing an array of cutaneous disorders. Two hundred forty-three (243) cases of otherwise unclassifiable lichenoid dermatitis were examined histologically employing a special cytokeratin stain. Occult squamous cell carcinoma was detected in three of the 243 cases, uncovered by special immunohistochemistry staining within histologic specimens of lichenoid dermatitis. We recommend staining for cutaneous cancer becoming a routine practice in evaluating cutaneous lichenoid dermatitis.
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23
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Ren Y, Liu Z, Makamure J, Kan X, Song S, Liu Y, Qian K, Zheng C, Liang B. Addition of Camrelizumab to Transarterial Chemoembolization in Hepatocellular Carcinoma With Untreatable Progression. Technol Cancer Res Treat 2022; 21:15330338221131385. [PMID: 36259117 PMCID: PMC9583233 DOI: 10.1177/15330338221131385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: The present retrospective study aimed to evaluate the efficacy and safety of camrelizumab addition to transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) with TACE-related untreatable progression (UP). Methods: Patients with HCC who received addition of camrelizumab due to UP after initial TACE treatment were enrolled at our institution between May 2019 and January 2021. Patients were assessed for tumor response, progression-free survival (PFS), and adverse events (AEs). Risk factors for PFS were evaluated with logistic regression analysis. Results: A total of 41 patients were included. The objective response rates (ORR) and disease control rates (DCR) were 24.4% and 61.0% at 2 to 3 months, and 12.2% and 58.5% at 6 months, respectively. The median PFS of the patients were 6 months (95% confidence interval [CI]: 3.8 months, 8.2 months). Of the 41 patients, 23 received camrelizumab combined with TACE (hereafter, camrelizumab-TACE) on whom 52 combined TACE procedures were performed, with a median of 2 procedures (range: 1-6) per patient. The remaining 18 patients received camrelizumab alone due to TACE contraindications. Multivariable analysis indicated that camrelizumab-TACE was an independent prognostic factor for PFS. Subgroup analysis showed a median PFS of 8 months in the camrelizumab-TACE group and 3 months in the camrelizumab monotherapy group (P < .001). No treatment-related mortalities occurred. Seventeen patients (41.5%) developed at least 1 type of AE after treatment with camrelizumab, with reactive cutaneous capillary endothelial proliferation (RCCEP) (n = 14, 34.1%) being the most common AE. Conclusion: Addition of camrelizumab to TACE offered an effective and safe treatment for HCC with UP.
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Affiliation(s)
- Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Ziyi Liu
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Joyman Makamure
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Songlin Song
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Yiming Liu
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China,Chuansheng Zheng, Department of Radiology,
Union Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan 430022, China.
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China,Hubei Provinve Key Laboratory of Molecular Imaging, Wuhan,
China,Bin Liang, Department of Radiology, Union
Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China.
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24
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Actualities in the Morphology and Immunohistochemistry of Cutaneous and Ocular Melanoma: What Lies Ahead? A Single-Centre Study. Biomedicines 2022; 10:biomedicines10102500. [PMID: 36289768 PMCID: PMC9599614 DOI: 10.3390/biomedicines10102500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
Abstract
Melanoma is the most aggressive melanocytic tumor whose incidence is continuously increasing worldwide. METHODS We highlight the morphological, immunohistochemistry, and particularities of various melanoma types based on the cases diagnosed in our department from 2017 to 2021. RESULTS We present 100 melanoma cases and one capsular nevus case. The most common type was nodular melanoma. The immunohistochemistry markers used were SRY-box transcription factor 10 (SOX10), S100 protein, human melanoma black 45 (HMB45), and melanoma antigen recognized by T cells 1 (Melan-A). Uveal melanoma and conjunctival melanoma represent particular tumors with independent prognostic factors. Uveal melanoma requires assessment of macrophages, microvascularisation, and mitoses. Sentinel lymph node metastases are essential targets that provide staging tools. Conjunctival melanoma and capsular nevi are diagnostic pitfalls. CONCLUSION Melanoma can appear in various forms, and sometimes the diagnosis might be unclear. Today, immunohistochemistry remains the most important tool in confirming the diagnosis and prognosis for this type of neoplasia.
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25
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Shreberk‐Hassidim R, Aizenbud L, Lussheimer S, Thomaidou E, Bdolah‐Abram T, Merims S, Popovtzer A, Maly A, Lotem M, Zlotogorski A. Dermatological adverse events under programmed cell death-1 inhibitors as a prognostic marker in metastatic melanoma. Dermatol Ther 2022; 35:e15747. [PMID: 36190005 PMCID: PMC9786241 DOI: 10.1111/dth.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/02/2022] [Accepted: 07/27/2022] [Indexed: 12/30/2022]
Abstract
Melanoma is widely treated with programmed cell death-1 (PD-1) inhibitors. As part of their anti-tumor immunity effect, they increase the susceptibility to cutaneous immune-related adverse events (cIRAE) among other autoimmune effects. To characterize the manifestations of cIRAE in melanoma patients treated with PD-1 inhibitors, and evaluate the correlation with tumor response. A retrospective study of 95 metastatic malignant melanoma patients treated with PD-1 inhibitors at the Hadassah Medical Center during 2013-2016. The most common cIRAE was pruritus reported by 39 (41%) patients. All other cIRAE were noted in 34 patients (35.8%), of which the most common cutaneous manifestation was vitiligo, demonstrated in 17 patients (17.9%) followed by various rashes (7.4%, including erythema multiforme, oral lichen planus, photosensitive rash, insect bite-like reaction, and urticaria), psoriasiform rash (3.2%), bullous pemphigoid (3.2%), and eczema (1%). Interestingly, higher response rates to immunotherapy were demonstrated in patients who developed pruritus (85%) and cIRAE (88%), with lower mortality rates in the cIRAE group (38.2%) versus the non-cIRAE group (70.5%, p = 0.002). cIRAE are common among malignant melanoma patients treated with PD-1 inhibitors and may be a marker for favorable prognosis.
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Affiliation(s)
- Rony Shreberk‐Hassidim
- Department of Dermatology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Lilach Aizenbud
- Department of Medicine (Medical Oncology)Yale University School of MedicineNew HavenConnecticutUSA
| | - Shalev Lussheimer
- Department of Internal Medicine E, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | | | - Tali Bdolah‐Abram
- The Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Sharon Merims
- Sharett Institute of Oncology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Alex Maly
- Department of Pathology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Michal Lotem
- Sharett Institute of Oncology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
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Hanami Y, Yamamoto T. [Artículo traducido] Liquen plano bulloso y no-ampolloso durante la terapia anti PD-1 para el cáncer de pulmón. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T1014-T1016. [DOI: 10.1016/j.ad.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/09/2021] [Indexed: 11/05/2022] Open
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Gao Z, Xu Y, Zu J, Wang X, Sun C, Qiu S, Guo Y, Ma K. The time window for the reversal of depigmentation from aggravation to recovery in a non-small-cell lung cancer patient with pre-existing vitiligo using anti-programmed cell death-1 therapy: A case report. Front Immunol 2022; 13:946829. [PMID: 36052082 PMCID: PMC9424493 DOI: 10.3389/fimmu.2022.946829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Immune checkpoint inhibitors have made remarkable breakthroughs in the treatment of lung cancer, bringing significant survival benefits to the patients. A number of adverse events aggravated by immunotherapy in patients with pre-existing autoimmune diseases have been reported in the past, especially skin toxicity, such as rash, pruritus, erythema, and vitiligo. However, whether the exacerbated autoimmune disease is reversible and when it will return to its original state after immunotherapy discontinuation is still inconclusive. In our report, we described a patient diagnosed with non-small cell lung cancer whose vitiligo was stable for about 10 years. We followed up and observed the patient’s skin depigmentation for the complete time window, from aggravation of application anti-programmed cell death-1 receptor antibody (anti-PD-1 antibody) to recovery after the withdrawal. We presented the objective images at particular time points using reflectance confocal microscopy and wood’s light. We found that the use of anti-PD-1 antibody aggravated in skin toxicity, but it was reversible, the time window from the beginning to recovery status was approximately 9 months. We used this real case scenario to explain the relationships between immunotherapy and autoimmune diseases.
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Affiliation(s)
- Zhiru Gao
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Yinghui Xu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Jianjiao Zu
- Dermatological Department, The First Hospital of Jilin University, Changchun, China
| | - Xu Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Chao Sun
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Shi Qiu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Ye Guo
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Kewei Ma
- Cancer Center, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Kewei Ma,
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ORSINI C, SANTI F, FIORANI D, SORRENTINO E, MALASPINA L, DANIELLI R, RUBEGNI P, CINOTTI E, RUSSO F. Usefulness of in-vivo reflectance confocal microscopy in patient with nivolumab induced Grover disease. Ital J Dermatol Venerol 2022; 157:386-387. [DOI: 10.23736/s2784-8671.22.07180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bullous and Non-Bullous Lichen Planus During Anti PD-1 Therapy for Lung Cancer. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:1014-1016. [DOI: 10.1016/j.ad.2021.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 04/22/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022] Open
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30
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Fadel CA, Danak SU, Jhaveri J, Caudell MD. The potentiation of radio sensitization by concomitant treatment with radiation therapy and a PDL-1 inhibitor in cutaneous squamous cell carcinoma. Adv Radiat Oncol 2022; 7:101021. [PMID: 36131995 PMCID: PMC9483777 DOI: 10.1016/j.adro.2022.101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Celine A. Fadel
- Internal Medicine Residency, Northeast Georgia Medical Center, Gainesville, Georgia
- Corresponding author: Celine A. Fadel, DO
| | - Shivang U. Danak
- Internal Medicine Residency, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Jaymin Jhaveri
- Northeast Georgia Physicians Group Radiation Oncology, Gainesville, Georgia
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Höller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022. Eur J Cancer 2022; 170:236-255. [PMID: 35570085 DOI: 10.1016/j.ejca.2022.03.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Bohdan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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Thomas M, Wazir A, Poudel A. Pembrolizumab-Induced Acute Skin Reaction: A Case Report and Review of Literature. Cureus 2022; 14:e26143. [PMID: 35754442 PMCID: PMC9216225 DOI: 10.7759/cureus.26143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
Abstract
The development of immune checkpoint inhibitors is considered to be one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-ligand 1 (PD-L1) receptor that has demonstrated antineoplastic activity against various malignancies including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab has been associated with significant dermatological adverse reactions, referred to as immune-related adverse events. The cutaneous adverse effects can affect the quality of life of the patient and can result in dose reduction or even discontinuation of the treatment. Hence it is of utmost importance to have a comprehensive understanding of the cutaneous toxicities for prompt initiation of treatment. We present the case of a 49-year-old male with metastatic non-small cell lung cancer (NSCLC) with 100% PD-L1 expression, who suffered a severe cutaneous reaction involving more than 95% of body surface area, following the first dose of pembrolizumab. He was treated with low-dose systemic steroids (prednisone 10 mg), to which he responded well. Since the patient showed excellent symptomatic and clinical response to pembrolizumab, it was not discontinued. The patient has not developed a rash with subsequent doses of pembrolizumab, and the steroids were tapered off.
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Yamamoto T. Skin Manifestation Induced by Immune Checkpoint Inhibitors. Clin Cosmet Investig Dermatol 2022; 15:829-841. [PMID: 35592732 PMCID: PMC9112343 DOI: 10.2147/ccid.s364243] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022]
Abstract
In accordance with recent therapeutic progress of immune checkpoint inhibitors for certain cancers, various disorders are induced as immune-related adverse events (irAEs) affecting the skin, gut, thyroid gland, lung, and liver. Among such irAEs, mucocutaneous manifestation is the most common. Cutaneous manifestations are categorized into several groups, ie, inflammatory reactions, immunobullous reactions, alterations of epidermal keratinocytes, and alterations of epidermal melanocytes; however, there are additionally various cutaneous toxicities, unclassified into those groups. Blocking of programmed cell death 1 (PD-1)/programmed cell death ligand 1(PDL1) can lead to the induction of autoimmune reaction, via activation of cytotoxic T cells, inhibition of regulatory T cell function, and alteration of cytokine balance. Similarly, blockade of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) reduces the suppressive function of regulatory T cells. Due to those mechanisms, various autoimmune conditions can be induced, in addition to nonspecific drug eruptions. Dermatologists should be aware of various types of those mucocutaneous manifestations, either common or rare, as well as the management of such conditions. Herein, various mucocutaneous manifestations of irAEs and cases involving Japanese patients have been described, based on a single institute's experience.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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Le TK, Kaul S, Cappelli LC, Naidoo J, Semenov YR, Kwatra SG. Cutaneous adverse events of immune checkpoint inhibitor therapy: incidence and types of reactive dermatoses. J DERMATOL TREAT 2022; 33:1691-1695. [PMID: 33656965 PMCID: PMC8458472 DOI: 10.1080/09546634.2021.1898529] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dermatoses are common and potentially serious complications of programmed cell death receptor PD-1 immune checkpoint inhibitor (anti-PD-1 ICI) therapy. Understanding their incidence is necessary to support clinical awareness, diagnosis, and management. OBJECTIVE To examine the incidence and odds of reported non-cancerous dermatoses in the setting of anti-PD-1 ICI therapy. METHODS Cross-sectional study of anti-PD-1 (pembrolizumab or nivolumab) treated patients at a tertiary healthcare institution. Selected dermatologic events following immunotherapy were identified in the electronic medical record. Comparator arm were patients that developed these same dermatoses without receiving anti-PD-1 ICI therapy. RESULTS There were 13.7% (254/1857) patients that developed one of 28 dermatoses. Compared with the general population, patients treated with anti-PD-1 had a greater risk for development of mucositis (OR 65.7, 95% CI 35.0-123.3), xerostomia (OR 11.9, 95% CI 8.4-16.8), pruritus (11.3, 95% CI 8.9-14.3), and lichen planus/lichenoid dermatitis (OR 10.7, 95% CI 5.6-20.7). CONCLUSIONS We report the frequency of dermatoses encountered in the setting of ICI therapy, both common (pruritus, rash, vitiligo) and uncommon (scleroderma, urticaria).
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Affiliation(s)
- Thomas K. Le
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Subuhi Kaul
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura C. Cappelli
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jarushka Naidoo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, MD, USA
| | | | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
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Fattizzo B, Rampi N, Barcellini W. Hematological and Extra-Hematological Autoimmune Complications after Checkpoint Inhibitors. Pharmaceuticals (Basel) 2022; 15:ph15050557. [PMID: 35631383 PMCID: PMC9143083 DOI: 10.3390/ph15050557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Checkpoint inhibitors (CPI) represent a novel therapeutical strategy with a high efficacy both in solid and hematological cancers. They act by reactivating the immune system against neoplastic cells but may, in turn, cause immune-related adverse events (IRAEs) involving several organs with variable frequency and severity. Up to 10% of CPI-treated patients experience hematological IRAEs, mainly cytopenias. The differential diagnosis is challenging due to underlying disease, previous treatments and the variable liability of available tests (i.e., the direct antiglobulin test, anti-platelet antibodies, etc.). Among extra-hematological IRAEs, cutaneous and endocrine ones are the most frequent (up to 30–50%), ranging from mild (pruritus, eczema and thyroid dysfunctions) to severe forms (bullous disorders, hypophysitis and diabetes), mostly requiring topic or replacement therapy. Gastroenteric and kidney toxicities occur in about 5% of patients, biopsies may support the diagnosis, and immunosuppressive treatment is required in severe cases. Finally, neurologic and cardiologic IRAEs, although rare, may be life-threatening and require prompt intervention. By reviewing the most recent literature on post-CPI IRAEs, it emerged that clinical suspicion and monitoring of laboratory markers of organ damage is pivotal to a prompt diagnosis. In severe cases, CPI should be discontinued and immunosuppressive therapy started, whilst rechallenge is anecdotal and should be carefully evaluated.
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Affiliation(s)
- Bruno Fattizzo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.R.); (W.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255033477
| | - Nicolò Rampi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.R.); (W.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (N.R.); (W.B.)
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Cutaneous immune-related adverse events among Taiwanese cancer patients receiving immune checkpoint inhibitors link to a survival benefit. Sci Rep 2022; 12:7021. [PMID: 35487955 PMCID: PMC9055047 DOI: 10.1038/s41598-022-11128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/13/2022] [Indexed: 01/13/2023] Open
Abstract
Cutaneous immune-related adverse events are common in cancer patients receiving immunotherapies but seldom studied in a comprehensive way of collecting all cancer types with comparisons between different immune-oncology drugs and correlation to patient survival. In this retrospective cohort study, we recruited 468 cancer patients receiving immunotherapies in a tertiary referral center in Taiwan and try to determine real-world incidence of cutaneous immune-related adverse events and their associations with the survival rates. Among them, 128 patients (27.4%) had cutaneous immune-related adverse events, with maculopapular eruption (10.6%) and pruritus (10.1%) most frequently identified in the monotherapy group. The incidence of these cutaneous immune-related adverse events was highest in patients receiving pembrolizumab (34.1%, P < .0001). Concurrent usage of molecular-targeted therapy with immunotherapy was associated with a higher incidence (57.8%, P < .0001). The Kaplan-Meier plot and log-rank test showed that patients with any type of immune-related cutaneous adverse events had longer survival time than those without (P < .0001). In conclusion, having either type of cutaneous immune-related adverse event in cancer patients receiving immunotherapies was correlated with a longer overall survival. Prompt diagnosis and suitable treatment are important.
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Almodovar Cruz GE, Kaunitz G, Stein JE, Sander I, Hollmann T, Cottrell TR, Taube JM, Sunshine JC. Immune cell subsets in interface cutaneous immune-related adverse events (cirAEs) associated with anti-PD-1 therapy resemble acute graft vs host disease more than lichen planus. J Cutan Pathol 2022; 49:701-708. [PMID: 35445765 PMCID: PMC9305991 DOI: 10.1111/cup.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
Background Checkpoint immunotherapy is frequently associated with cutaneous immune‐related adverse events (cirAEs), and among those, the most common subtype shows interface reaction patterns that have been likened to lichen planus (LP); however, cutaneous acute graft versus host disease (aGVHD) may be a closer histopathologic comparator. We used quantitative pathology to compare the immunologic composition of anti‐PD‐1‐associated interface reactions to LP and aGVHD to assess for similarities and differences between these cutaneous eruptions. Methods Immunohistochemistry for CD4, CD8, CD68, PD‐1, and PD‐L1 was performed on formalin‐fixed paraffin‐embedded tissue from patients with anti‐PD‐1 interface cirAEs (n = 4), LP (n = 9), or aGVHD (n = 5). Densities of immune cell subsets expressing each marker were quantified using the HALO image analysis immune cell module. Plasma cell and eosinophil density were quantified on routine H&E slides. Results Specimens from patients with anti‐PD‐1 interface cirAEs showed equivalent total cell densities and immune cell composition to those with aGVHD. Patients with LP showed higher total immune cell infiltration, higher absolute T‐cell densities, increased CD8 proportion, and reduced histiocytic component. The cases with the highest plasma cell counts were all anti‐PD‐1 interface cirAEs and aGVHD. Conclusion The composition of immune cell subsets in anti‐PD‐1 interface cirAEs more closely resembles the immune response seen in aGVHD than LP within our cohort. This warrants a closer look via advanced analytics and may have implications for shared pathogenesis and potential treatment options.
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Affiliation(s)
- Guillermo E Almodovar Cruz
- The Department of Dermatology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD
| | - Genevieve Kaunitz
- The Department of Dermatology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD.,The Department of Dermatology at University of California San Diego School of Medicine, San Diego, CA
| | - Julie E Stein
- The Department of Pathology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD
| | - Inbal Sander
- The Department of Dermatology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD
| | - Travis Hollmann
- The Department of Pathology at Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tricia R Cottrell
- The Department of Pathology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD.,The Department of Pathology and Molecular Medicine at Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Janis M Taube
- The Department of Dermatology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD.,The Department of Pathology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD.,The Department of Oncology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD
| | - Joel C Sunshine
- The Department of Dermatology at Johns Hopkins University School of Medicine, the Sidney Kimmel Comprehensive Cancer Center, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD
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Chen CH, Yu HS, Yu S. Cutaneous Adverse Events Associated with Immune Checkpoint Inhibitors: A Review Article. Curr Oncol 2022; 29:2871-2886. [PMID: 35448208 PMCID: PMC9032875 DOI: 10.3390/curroncol29040234] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have emerged as novel options that are effective in treating various cancers. They are monoclonal antibodies that target cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD-1), and programmed cell death-ligand 1 (PD-L1). However, activation of the immune systems through ICIs may concomitantly trigger a constellation of immunologic symptoms and signs, termed immune-related adverse events (irAEs), with the skin being the most commonly involved organ. The dermatologic toxicities are observed in nearly half of the patients treated with ICIs, mainly in the form of maculopapular rash and pruritus. In the majority of cases, these cutaneous irAEs are self-limiting and manageable, and continuation of the ICIs is possible. This review provides an overview of variable ICI-mediated dermatologic reactions and describes the clinical and histopathologic presentation. Early and accurate diagnosis, recognition of severe toxicities, and appropriate management are key goals to achieve the most favorable outcomes and quality of life in cancer patients.
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Affiliation(s)
- Chieh-Hsun Chen
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
| | - Hsin-Su Yu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
| | - Sebastian Yu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan;
- Department of Dermatology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 6103)
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Juan-Carpena G, Palazón-Cabanes J, Blanes-Martínez M. [Translated article] Characteristics, Management, and Prognostic Implications of Adverse Effects of Immune Checkpoint Inhibitors: A Systematic Review. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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40
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Maheshwari A, Shankar A, Tyagi K, Verma R. Dermatological Aspects of Nursing Oncology: Meaningful Observations Ensuring Better Quality of Life. Indian J Palliat Care 2022; 28:216-220. [PMID: 35673687 PMCID: PMC9168281 DOI: 10.25259/ijpc_147_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/30/2022] [Indexed: 12/03/2022] Open
Abstract
Modern cancer management has changed over the period of time and now shifted to multidisciplinary care approach to ensure a better quality of life (QOL) of the surfing patients. Every form of cancer treatment has side effects and affects the QOL. Many of the side effects have been discussed in detail because of the need for timely interventions to prevent the consequences of the side effects. Dermatological adverse events due to cancer treatment are important but most commonly ignored in our clinical practice. Nursing staffs have a critical role in the early identification of such events and by briefing and training of the nursing staff in the identification of adverse events which can aid in the prevention of complications. As dermatologists may not be available round the clock, nursing staff are looking after the patients round the clock can prove very vital in screening cutaneous AE and adequately setting up referrals to aid early recognition and treatment of not only mild but also potentially life-threatening complications. The nursing staff, which is a cadre of health caregivers that are intimately involved in cancer care, can be trained to identify timely, skin-related adverse events. A literature search of scientific publications was done using the electronic databases PubMed, Science Direct, Cochrane Library, and Google Scholar. The search included terms 'Adverse events (AEs) post-chemotherapy,' 'AE post-radiotherapy,' 'AE post-immunotherapy,' 'AE post-hormonal therapy for cancer' and 'AE post-cancer surgery.' Data obtained from these studies and case reports were compiled and interpreted to prepare this review. This review focuses on various ways in which skin can be involved adversely as a part of cancer management and their classic and tell-tale signs to help the nurses in their better and quicker identification so that dermatologists are timely intimated and the treatment can be instituted to improve the patient's QOL.
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Affiliation(s)
- Apoorva Maheshwari
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kashish Tyagi
- Department of Dermatology, Medanta Medicity, Gurgaon, Haryana, India
| | - Richa Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Delhi, India
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Juan-Carpena G, Palazón-Cabanes J, Blanes-Martínez M. Revisión sistemática de los efectos adversos cutáneos causados por fármacos inhibidores de los puntos de control inmunitario: características, manejo y pronóstico. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:376-387. [DOI: 10.1016/j.ad.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/19/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022] Open
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Sueki H, Watanabe Y, Sugiyama S, Mizukawa Y. Drug allergy and non-HIV immune reconstitution inflammatory syndrome. Allergol Int 2022; 71:185-192. [PMID: 35236619 DOI: 10.1016/j.alit.2021.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/16/2022] Open
Abstract
Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory disorders caused by antigens, including drugs or pathogenic microorganisms present prior to immune recovery, or by the exacerbation of an inflammatory disorder that was already present. Drug-induced hypersensitivity syndrome is a prototype of IRIS, and the pathophysiology of non-HIV IRIS can be recognized in several disorders treated with corticosteroids, immunosuppressants, molecular-targeted drugs, TNF-α antibody drugs, immune checkpoint inhibitors, and dipeptidyl peptidase-4 inhibitors. This review focuses on the relationship between the immune mechanism of non-HIV IRIS and drug allergies, especially severe drug eruption. The antigen recognition mechanism in drug allergy varies depending on the clinical type and the causative drug. The p-i concept is the main mechanism in severe drug eruption such as Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Lymphocytes activated by an antigen other than a drug, such as a virus, can also develop drug allergy by the loose binding of drugs with immune receptors of T cells or human leukocyte antigen. Therefore, fluctuations in the immune environment affect the onset of severe drug eruption. Novel agents that cause major changes in immunity have been marketed mainly for autoimmune diseases and malignant tumors; therefore, it is necessary to consider their effects when treating severe drug eruptions. Moreover, although a list of diagnostic criteria for this syndrome has been drafted, predictive and diagnostic biomarkers for this syndrome needs to be urgently developed.
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Song G, Zhang FF, Cheng HD. Thalidomide for prevention of camrelizumab-induced reactive cutaneous capillary endothelial proliferation. Australas J Dermatol 2022; 63:217-221. [PMID: 35229882 PMCID: PMC9313837 DOI: 10.1111/ajd.13812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 01/10/2023]
Abstract
Objectives The study evaluated the efficacy of thalidomide in prevention of camrelizumab‐induced reactive cutaneous capillary endothelial proliferation (RCCEP). Methods In this study, patients treated with camrelizumab plus thalidomide or camrelizumab alone were included. The occurrences, onset time, severity of RCCEP and the adverse effect of thalidomide were analysed. Results A total of 19 patients were enrolled. The incidence of RCCEP in thalidomide group (2/9, 22.2%) was significantly lower than that in camrelizumab group (8/10, 80%). The median onset time of RCCEP was 5 weeks and 4 weeks respectively. The adverse events of thalidomide were mild, and no treatment‐associated interruption was observed. Conclusions Thalidomide showed a promising in prevention of the RCCEP in patients receiving camrelizumab therapy with an acceptable safety profile.
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Affiliation(s)
- Geng Song
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei-Fei Zhang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huai-Dong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Campana F, Lan R, Girard C, Rochefort J, Le Pelletier F, Leroux-Villet C, Mares S, Millot S, Zlowodzki AS, Sibaud V, Tessier MH, Vaillant L, Fricain JC, Samimi M. French guidelines for the management of oral lichen planus (excluding pharmacological therapy). Ann Dermatol Venereol 2022; 149:14-27. [PMID: 34238586 DOI: 10.1016/j.annder.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/16/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Oral lichen is a chronic inflammatory disease for which diagnostic management and follow-up are heterogeneous given the absence of specific guidelines in France. Our objective was to develop French multidisciplinary guidelines for the management of oral lichen. MATERIALS AND METHODS Working groups from the Groupe d'Etude de la Muqueuse Buccale (GEMUB) formulated a list of research questions and the corresponding recommendations according to the "formal consensus" method for developing practice guidelines. These recommendations were submitted to a group of experts and the degree of agreement for each recommendation was assessed by a scoring group. RESULTS Twenty-two research questions, divided into 3 themes (nosological classification and initial assessment, induced oral lichenoid lesions, and follow-up) resulted in 22 recommendations. Initial biopsy for histology is recommended in the absence of reticulated lesions. Biopsy for direct immunofluorescence is recommended for ulcerated, erosive, bullous types and for diffuse erythematous gingivitis. Management should include a periodontal and dental check-up, and investigation for extra-oral lesions. Hepatitis C testing is recommended only if risk factors are present. Definitions, triggering factors and the management of "induced oral lichenoid lesions" were clarified. Oral lichen must be monitored by a practitioner familiar with the disease at least once a year, using objective tools. CONCLUSION This formalised consensus of multidisciplinary experts provides clinical practice guidelines on the management and monitoring of oral lichen.
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Affiliation(s)
- F Campana
- Aix Marseille Univ, APHM, INSERM, MMG, Hôpital de la Timone, Unité de chirurgie orale, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - R Lan
- Aix Marseille Univ, APHM, CNRS, EFS, ADES, Hôpital de la Timone, Unité de chirurgie orale, 264 Rue Saint-Pierre, 13005 Marseille, France
| | - C Girard
- Dermatologie, CHU de Montpellier, 34295 Montpellier cedex, France
| | - J Rochefort
- Odontologie, Hôpital La Pitié Salpetrière - Université Paris Diderot, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - F Le Pelletier
- Anatomie Pathologique, Hôpital La Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Leroux-Villet
- Dermatologie, Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - S Mares
- Chirurgie Maxillo-faciale, Hôpital La Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Millot
- Chirurgie Orale, CHU de Montpellier, 34295 Montpellier cedex, France
| | | | - V Sibaud
- Dermatologie, IUCT Oncopôle, 31000 Toulouse, France
| | - M-H Tessier
- Dermatologie, CHU de Nantes, 44000 Nantes, France
| | - L Vaillant
- Dermatologie, CHU de Tours, Université de Tours, 37000 Tours, France
| | - J-C Fricain
- Université de Bordeaux, INSERM U1026, service de chirurgie orale, CHU Bordeaux, 33000 Bordeaux, France
| | - M Samimi
- Dermatologie, CHU de Tours, Université de Tours, 37000 Tours, France.
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Wongvibulsin S, Pahalyants V, Kalinich M, Murphy W, Yu KH, Wang F, Chen ST, Reynolds K, Kwatra SG, Semenov YR. Epidemiology and risk factors for the development of cutaneous toxicities in patients treated with immune-checkpoint inhibitors: A United States population-level analysis. J Am Acad Dermatol 2022; 86:563-572. [PMID: 33819538 PMCID: PMC10285344 DOI: 10.1016/j.jaad.2021.03.094] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A variety of dermatoses have been reported in the growing number of patients treated with immune-checkpoint inhibitors (ICIs), but the current understanding of cutaneous immune-related adverse events (irAEs) is limited. OBJECTIVE To determine the cumulative incidence, distribution, and risk factors of cutaneous irAEs after ICI initiation. METHODS This was a retrospective cohort study of patients in a national insurance claims database including cancer patients treated with ICIs and matched controls. RESULTS The study included 8637 ICI patients and 8637 matched controls. The overall incidence of cutaneous irAEs was 25.1%, with a median onset time of 113 days. The ICI group had a significantly higher incidence of pruritus, mucositis, erythroderma, maculopapular eruption, vitiligo, lichen planus, bullous pemphigoid, Grover disease, rash, other nonspecific eruptions, and drug eruption or other nonspecific drug reaction. Patients with melanoma and renal cell carcinoma and those receiving combination therapy were at a higher risk of cutaneous irAEs. LIMITATIONS Retrospective design without access to patient chart data. CONCLUSIONS This study identifies cutaneous irAEs in a real-world clinical setting and highlights patient groups that are particularly at risk. The results can aid dermatologists at the bedside in the diagnosis of cutaneous irAEs and in formulating management recommendations to referring oncologists regarding the continuation of ICI therapy.
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Affiliation(s)
- Shannon Wongvibulsin
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vartan Pahalyants
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard Business School, Boston, Massachusetts
| | - Mark Kalinich
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William Murphy
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Harvard Business School, Boston, Massachusetts
| | - Kun-Hsing Yu
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Feicheng Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts; Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerry Reynolds
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Public Health, Johns Hopkins University Bloomberg, Baltimore, Maryland
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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Garcia-Melendo C, Morales-Munera CE, Dalmau J, Cubiró X, López-Sánchez C, Mozos A, Yélamos O. Extensive lichen planopilaris as exclusive lichenoid reaction secondary to pembrolizumab in a patient with metastatic melanoma. Dermatol Ther 2022; 35:e15388. [PMID: 35174945 DOI: 10.1111/dth.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Joan Dalmau
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau
| | - Xavier Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau
| | | | - Anna Mozos
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona
| | - Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau
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47
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Chatterjee T, Rashid TF, Syed SB, Roy M. Bullous Pemphigoid Associated With Pembrolizumab Therapy for Non-Small-Cell Lung Cancer: A Case Report. Cureus 2022; 14:e21770. [PMID: 35251840 PMCID: PMC8890109 DOI: 10.7759/cureus.21770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
Pembrolizumab is an immune checkpoint inhibitor being increasingly used as immunotherapy for a multitude of cancers. With the increasing use of these agents, various immune-related adverse events are being recognized. Lichenoid reaction, pruritus, and eczema are well-established cutaneous side effects of pembrolizumab, but bullous pemphigoid (BP) is a rare side effect of the drug. It is difficult to establish this diagnosis because it needs a detailed history of the timeline of the evolution of symptoms and careful ruling out of other etiologies, especially other drugs. Here, we present the case of a 66-year-old male who developed BP after receiving pembrolizumab therapy for non-small-cell lung cancer. Discontinuation of pembrolizumab and the use of topical and systemic steroids led to the complete resolution of symptoms. Physicians should be aware of this potential complication and keep it on their differential diagnosis when treating patients on immune checkpoint inhibitors.
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48
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VISTA, PDL-L1, and BRAF-A Review of New and Old Markers in the Prognosis of Melanoma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010074. [PMID: 35056382 PMCID: PMC8778318 DOI: 10.3390/medicina58010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 12/26/2022]
Abstract
Melanoma is currently known as one of the most aggressive malignant tumors. The prognostic factors and particularities of this neoplasm are a persistent hot topic in the medical field. This review has multiple purposes. First, we aim to summarize the known data regarding the histological and immunohistochemical appearance of this versatile tumor and to look further into the analysis of several widely used prognostic markers, such as B-Raf proto-oncogene, serine/threonine kinase BRAF. The second purpose is to analyze the data on the new prognostic markers, V-domain Immunoglobulin Suppressor of T cell Activation (VISTA) and Programmed death-ligand 1 (PD-L1). VISTA is a novel target that is considered to be highly important in determining the invasive potential and treatment response of a melanoma, and there are currently only a limited number of studies describing its role. PD-L1 is a marker with whose importance has been revealed in multiple types of malignancies, but its exact role regarding melanoma remains under investigation. In conclusion, the gathered data highlights the importance of correlations between these markers toward providing patients with a better outcome.
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49
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Liu X, Wang H, Wan Y, Guo Y, Shan SJ. Acquired Perforating Dermatosis Induced by PD-1 Inhibitor: A Case Report. Am J Dermatopathol 2021; 43:942-944. [PMID: 34291739 DOI: 10.1097/dad.0000000000002026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Acquired perforating dermatoses (APDs) are a group of diverse skin disorders in patients with systemic disease, most commonly chronic renal failure and diabetes mellitus. APD induced by medication has seldom been reported. Anti-PD-1 monoclonal antibody has recently been used as a broad-spectrum, effective, durable, and relatively safe antitumor therapy for various malignancies. Thus far, known side effects involving skin have included rash, pruritus, and vitiligo. Here, we present a rare case of a unilateral linear eruption with histopathologic features of APD in a 36-year-old man during treatment with Terepril monoclonal antibody. To the best of our knowledge, APD induced by the PD-1 inhibitor has not been described in the medical literature.
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Affiliation(s)
- Xiaoyan Liu
- Department of Dermatology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Dermatology, Affiliated Hospital of Chengde Medical College
| | - Huayang Wang
- Department of Dermatology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yinsheng Wan
- Department of Biology, Providence College, Providence, RI; and
| | - Ying Guo
- Ackerman Academy of Dermatopathology, New York, NY
| | - Shi-Jun Shan
- Department of Dermatology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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50
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Liu LY, Teng JMC, Spunt SL, Strelo JL, Kwong BY, Zaba LC. Dermatologic toxicities of targeted antineoplastic agents and immune checkpoint inhibitor therapy in pediatric patients: A systematic review. Pediatr Blood Cancer 2021; 68:e29346. [PMID: 34569142 DOI: 10.1002/pbc.29346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022]
Abstract
Cutaneous adverse events (cAEs) from targeted antineoplastic agents and immune checkpoint inhibitors are common in children with cancer and may lead to dose reduction or cessation of critical oncologic treatment. Timely diagnosis and proper management of cAEs in pediatric oncology patients is essential to optimize ongoing cancer-directed therapy and improve quality of life. This systematic review of published studies summarizes dermatologic toxicities to targeted anticancer treatments and immune checkpoint inhibitors.
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Affiliation(s)
- Lucy Y Liu
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Joyce M C Teng
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Department of Dermatology, Division of Pediatric Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Sheri L Spunt
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Jenna L Strelo
- Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California, USA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California, USA
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, Stanford, California, USA
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