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Kemanetzi C, Lallas K, Lazaridou E, Papageorgiou C, Lallas A, Stratigos A, Timotheadou E, Lazaridis G, Dionysopoulos D, Kalaitzi K, Tsimpidakis A, Trakatelli M, Patsatsi A, Nikolao V, Apalla Z. The Impact of Immune Checkpoint Inhibitors-Induced Skin Toxicity on Patients Quality of Life and the Role of Dermatologic Intervention. Dermatol Pract Concept 2024; 14:dpc.1403a118. [PMID: 39122524 PMCID: PMC11314511 DOI: 10.5826/dpc.1403a118] [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: 01/14/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Data regarding quality of life (QoL) of oncologic patients experiencing dermatologic immune-related adverse events (dirAEs) and their course after dermatologic intervention are scarce. OBJECTIVES To assess the impact of dirAEs on patients QoL and to investigate the correlation between dermatologic and oncologic indexes used for estimating QoL. METHODS We enrolled oncologic patients with dirAEs managed in two supportive onco-dermatology outpatient clinics in Greece. Patient-reported outcomes included DLQI, EORTC-QLQ-C30 and Numerical Rating Scale for pruritus (pNRS). RESULTS Overall, 110 patients were enrolled in the study. Mean (standard deviation) DLQI and pNRS scores were 15.54 (5.44) and 7.25 (2.95), correspondingly, while functional, symptom and summary scores of EORTC-C30 were 79.17 (2.11), 17.66 (3.60) and 80.67 (3.08), respectively. After therapeutic interventions, there was a statistically significant decrease in DLQI scores after first intervention compared to baseline, and second intervention compared to first (mean decrease 4.38 (2.91), P < 0.001 and 5.16 (3.99), P < 0.001, respectively). DLQI showed no correlation with global health status/QoLs (rho 0.01, P = 0.90) of EORTC-C30. CONCLUSIONS DirAEs negatively affect QoL. Dermatologic intervention improves patients QoL, facilitating an unimpaired oncologic treatment. Poor correlation between DLQI and EORTC-QLQ-30 highlights the need for adapted QoL measurement tools in the context of immune checkpoint inhibitors treatment.
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Affiliation(s)
- Christina Kemanetzi
- Second Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Konstantinos Lallas
- Oncology Department, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Elizavet Lazaridou
- Second Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Chrysoula Papageorgiou
- Second Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Eleni Timotheadou
- Oncology Department, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - George Lazaridis
- Oncology Department, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Dimitrios Dionysopoulos
- Oncology Department, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Antonios Tsimpidakis
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Myrto Trakatelli
- Second Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Aikaterini Patsatsi
- Second Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki Nikolao
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Zoe Apalla
- Second Department of Dermatology, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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Bray ER, Lin RR, Li JN, Elgart GW, Elman SA, Maderal AD. Immune checkpoint inhibitor associated epidermal necrosis, beyond SJS and TEN: a review of 98 cases. Arch Dermatol Res 2024; 316:233. [PMID: 38795205 DOI: 10.1007/s00403-024-03061-6] [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: 03/22/2024] [Revised: 04/14/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Immune checkpoint inhibitor (ICI) therapies carry the risk of major immune-related adverse events (irAEs). Among the most severe irAEs is epidermal necrosis that may clinically mimic Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN). The aim of this study was to provide a summary of the clinical and histological features of ICI-associated epidermal necrosis, with a special focus on factors associated with fatal outcomes in cases of extensive disease. A total of 98 cases, 2 new cases and 96 reported on PubMed and in the literature, of ICI-associated epidermal necrosis were assessed. Development of epidermal necrosis occurred between 1 day and 3 years after starting ICI therapy, with an average onset of 13.8 weeks for patients with limited (< 30% BSA) and 11.3 weeks for those with extensive (≥ 30% BSA) involvement, and a median onset of 5.8 weeks and 4 weeks respectively. A preceding rash was seen in 52 cases and was more common in extensive cases. Mucosal involvement was only reported in 65% of extensive cases but was significantly associated with fatal reactions. Co-administration of cytotoxic chemotherapy was associated with more extensive disease. Recovery was observed in 96% and 65% of those with limited and extensive involvement respectively and no specific therapy was associated with improved survival. Young age was significantly associated with poor outcomes in extensive disease, the average age of surviving patients was 64.5 years old versus 55.1 years old for deceased patients, p < 0.01. Both superficial perivascular and interface/lichenoid inflammatory infiltrates were commonly seen. These findings suggest that ICI-associated epidermal necrosis should be considered a distinct clinical entity from drug-induced SJS/TEN.
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Affiliation(s)
- Eric R Bray
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A Miami, Miami, FL, 33136, USA.
- Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA.
| | - Rachel R Lin
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A Miami, Miami, FL, 33136, USA
| | - Jeffrey N Li
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A Miami, Miami, FL, 33136, USA
- Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA
| | - George W Elgart
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A Miami, Miami, FL, 33136, USA
- Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA
| | - Scott A Elman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A Miami, Miami, FL, 33136, USA
- Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA
| | - Andrea D Maderal
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 N.W. 10th Avenue, RMSB, Room 2023-A Miami, Miami, FL, 33136, USA
- Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL, 33136, USA
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3
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Mannino M, Sollena P, Di Stefani A, Rossi E, D'Argento E, Schinzari G, Tortora G, Peris K. Quality of Life Impact in Patients with Cutaneous Toxicities Caused by Epidermal Growth Factor Receptor Inhibitors and Immunotherapy. Dermatology 2024; 240:523-530. [PMID: 38631324 DOI: 10.1159/000536332] [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: 10/14/2022] [Accepted: 12/27/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Novel oncologic therapies, including epidermal growth factor receptor inhibitors (EGFR-Is) and immune checkpoint inhibitors (ICIs), are associated with a new spectrum of adverse reactions, with prominent cutaneous toxicities. The impact of cutaneous adverse events (cAEs) on patients' quality of life (QoL) represents an unmet clinical need. OBJECTIVES The aims of this study were (1) to assess whether cutaneous toxicities directed therapies are effective in reducing the QoL burden via the submission of 2 patient reported outcome measures (PROMs); (2) to investigate whether class of oncologic therapy, type of cAE and toxicity severity differently impact on patients' QoL. METHODS A prospective observational study was conducted at the Dermatology department of the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, from October 2018 to October 2019. Patients aged ≥18 years, under therapy with EGFR-Is or ICIs and experiencing a treatment-related cAE were eligible for the study. Dermatology Life Quality Index (DLQI) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 version 3.0 (EORTC QLQ-C30) were administered to patients at first clinical visit (T0), at 1-month (T1), and at 3-month (T2) dermatological follow-up. RESULTS Sixty cAEs of 51 patients have been recorded. A significant difference in the mean score for both DLQI and EORTC QLQ-C30 was found along the 3-months dermatological follow-up (p < 0.0001). A similar QoL improvement was reported for PROMs stratified by class of therapy and toxicity severity (p < 0.0001). No difference was reported for patients with pyogenic granuloma-like lesions and psoriasiform eruption as per DLQI. Class of therapy and toxicity severity did not differently impact on patients' QoL at selected timepoints; we reported a higher EORTC QLQ-C30 score at T2 for patients developing psoriasiform eruption compared to other types of cAEs. CONCLUSIONS Early patients' referral to dermatologists and tailored management could result in better QoL.
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Affiliation(s)
- Maria Mannino
- U.O.C. di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Sollena
- U.O.C. di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Alessandro Di Stefani
- U.O.C. di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ettore D'Argento
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del S. Cuore, Rome, Italy
| | - Giampaolo Tortora
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del S. Cuore, Rome, Italy
| | - Ketty Peris
- U.O.C. di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Dreno B, Khosrotehrani K, De Barros Silva G, Wolf JR, Kerob D, Trombetta M, Atenguena E, Dielenseger P, Pan M, Scotte F, Krakowski I, Lacouture M. The role of dermocosmetics in the management of cancer-related skin toxicities: international expert consensus. Support Care Cancer 2023; 31:672. [PMID: 37925388 PMCID: PMC10625513 DOI: 10.1007/s00520-023-08116-4] [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] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 11/06/2023]
Abstract
Skin toxicities are very common in patients undergoing cancer treatment and have been found to occur with all types of cancer therapeutic interventions (cytotoxic chemotherapy, targeted therapies, immunotherapy, and radiotherapy). Further, skin toxicities can lead to interruption or even discontinuation of anticancer treatment in some patients, translating to suboptimal outcomes. Dermocosmetics (or cosmeceuticals)-defined as skincare solutions incorporating dermatologically active ingredients (beyond vehicle effects) that directly improve symptoms of various skin conditions-are increasingly being used in cancer care to prevent and manage skin toxicities. The active ingredients in these products have a measurable biological action in skin; they typically improve skin integrity (barrier function/hydration and other factors) while relieving skin symptoms. The Association Francophone des Soins Oncologiques de Support (AFSOS) and Multinational Association of Supportive Care in Cancer (MASCC) partnered to select a multidisciplinary group of healthcare professionals involved in the management of patients with cancer and skin toxicities. The group reviewed existing literature and created a summary of recommendations for managing these toxicities through online meetings and communication. In this publication, the group (1) reviews new skin toxicities seen with oncology drugs and (2) evaluates the role of dermocosmetics in improving patient outcomes and minimizing cancer treatment interruptions. We provide general recommendations for initiation and selection of skin care in all oncology patients as well as recommendations for what factors should be considered when using dermocosmetics in specific types of skin toxicities.
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Affiliation(s)
- Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in Immunotherapy, INCIT, UMR 1302/EMR6001. F-44000, Nantes, France
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Australia
| | | | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mark Trombetta
- Department of the Radiologic Sciences, Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, PA, USA
| | - Etienne Atenguena
- Department of Internal Medicine, University of Yaoundé I, Yaoundé Hospital General, Yaoundé, Cameroon
| | - Pascale Dielenseger
- Research and Education for Paramedic Professionals Nursing Coordinator, Gustave Roussy, Villejuif, France
- École Des Sciences du Cancer, Université Paris Sud (XI), Paris, France
- Association Française Des Infirmières de Cancerologie (AFIC), Paris, France
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Florian Scotte
- Interdisciplinary Patient Pathway Division, Gustave Roussy, Villejuif, France
- Multinational Association of Supportive Care in Cancer (MASCC), Aurora, Canada
| | - Ivan Krakowski
- Medical Oncologist, Bordeaux, France
- Association Francophone Des Soins Oncologiques de Support (AFSOS), Bègles, France
| | - Mario Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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5
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Thompson LL, Said JT, Li EB, Yoon J, Krasnow NA, Molina GE, Polyakov NJ, Foreman RK, LeBoeuf NR, Chen ST. Diagnostic accuracy of general dermatologists and supportive oncodermatologists for biopsied cutaneous immune-related adverse events. Support Care Cancer 2022; 30:7827-7831. [PMID: 35804176 PMCID: PMC9993019 DOI: 10.1007/s00520-022-07233-w] [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] [Received: 08/27/2021] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Supportive oncodermatology has been shown to improve several aspects of care for patients with cancer, but research showing improved diagnostic accuracy as a benefit of supportive oncodermatology is largely lacking. We thus aimed to evaluate different dermatologist groups' diagnostic accuracy for heterogenous cutaneous toxicities, using cutaneous immune-related adverse events (cirAEs) from immune checkpoint inhibitors (ICIs) as a test model. METHODS Billing/requisition codes were used to identify patients who initiated programmed death-1/ligand-1 (PD-1/PD-L1) ICIs between 2010 and 2019 at Dana-Farber Cancer Institute/Brigham and Women's Hospital/Massachusetts General Hospital and underwent a subsequent skin biopsy. For each biopsied cirAE, pre-biopsy clinical diagnoses and post-biopsy clinico-pathologic diagnoses were retrospectively obtained from the medical record. Each biopsy-ordering dermatology provider was categorized as a general dermatologist or supportive oncodermatologist on the basis of providing clinical care within a cancer-center or attending on a hospital/clinic service dedicated to anti-cancer drug-related skin toxicities. RESULTS Of 4,183 patients who initiated anti-PD-1/PD-L1 therapy between 2010 and 2019, 101 (2.4%) patients collectively had 104 biopsied cirAEs. In more than one-third of all reviewed biopsied cirAEs (n = 39, 37.5%), histopathology results frequently led to revision of the pre-biopsy clinical diagnosis. The rate of initial cirAE misclassification amongst supportive oncodermatologists was significantly lower than that amongst general dermatologists (18/66, 27.3% vs. 21/38, 55.3%; Fischer's-exact-test p = 0.006). CONCLUSION Experienced supportive oncodermatologists may benefit patient care through increased diagnostic accuracy for skin toxicities from ICIs. Collectively, these results underscore that both skin biopsy from any dermatology provider and oncodermatology referral (where available) are valuable resources that should be integrated into supportive cancer care.
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Affiliation(s)
- Leah L Thompson
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital & Harvard Medical School, 221 Longwood Avenue, Boston, MB, 02215, USA
| | - Edward B Li
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Jaewon Yoon
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Nira A Krasnow
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Gabriel E Molina
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Nicole J Polyakov
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Ruth K Foreman
- Department of Pathology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital & Harvard Medical School, 221 Longwood Avenue, Boston, MB, 02215, USA.
- Center for Cutaneous Oncology, Dana Farber Cancer Institute, Boston, MA, 02114, USA.
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
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Park BC, Jung S, Chen ST, Dewan AK, Johnson DB. Challenging Dermatologic Considerations Associated with Immune Checkpoint Inhibitors. Am J Clin Dermatol 2022; 23:707-717. [PMID: 35708849 DOI: 10.1007/s40257-022-00706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
Immune checkpoint inhibitors have emerged as a new paradigm in oncologic care for many malignancies. However, nonspecific immune activation has led to "collateral damage" in the form of immune-related adverse events, with skin being a commonly affected organ. Cutaneous immune-related adverse events include a wide spectrum of clinical presentations and challenging considerations, often necessitating dermatology referral to support diagnosis and management, particularly for atypical presentations or more severe, cutaneous immune-related adverse events that may require specialized dermatologic evaluations including biopsy and histopathology. Close collaborations between oncologists and dermatologists may optimize clinical decision making in the following challenging management settings: non-steroidal therapies for corticosteroid-refractory, cutaneous immune-related adverse events, immune checkpoint inhibitor rechallenge, balancing cutaneous immune-related adverse events and treatments, and immune checkpoint inhibitors in patients with pre-existing autoimmune disease, skin conditions, and organ transplants. These complex clinical decisions that often lack rigorous data should be made in close collaboration with dermatologists to minimize unnecessary morbidity and mortality. This article provides a review of approaches to challenging dermatologic considerations associated with immune checkpoint inhibitor therapies.
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Affiliation(s)
- Benjamin C Park
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Seungyeon Jung
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Steven T Chen
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 3723, USA.
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Teimouri A, Minard LV, Scott SN, Daniels A, Snow S. Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events. Curr Oncol 2022; 29:3104-3117. [PMID: 35621642 PMCID: PMC9139722 DOI: 10.3390/curroncol29050252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) affect immunologic homeostasis, leading to immune-related adverse events (irAEs). Early irAE detection and management can prevent significant morbidity and mortality. A retrospective chart review was performed to characterize irAEs associated with nivolumab, ipilimumab, and nivolumab plus ipilimumab in adult medical oncology patients in Nova Scotia Health-Central Zone from 2013–2020, and to describe adherence to toxicity management guidelines. Diarrhea/colitis, hepatitis, pneumonitis, nephrotoxicity, and cardiotoxicity were studied. Of 129 charts reviewed, 67 patients (51.9%) experienced at least one irAE for a total of 98 irAEs and a 1.5% fatality rate. Of these irAEs, 33.7% led to an emergency room visit. Patients were admitted to hospital and steroids were used in 24.5% and 35.7% of cases, respectively. In 17.3% of irAEs, ICIs were permanently discontinued. In 20.4% of irAEs, ICIs were held, and patients were monitored; while in 18.4%, ICIs were held until the irAE was Grade 0–1 (and until steroids were tapered). Almost 47% of irAEs were managed according to guidelines (14.3% were not), and 38.8% had no documented management. Patients receiving immunotherapy frequently experience irAEs with half of irAEs having documented management adhering to guidelines. As immunotherapy indications expand, it is important to ensure irAEs are documented and managed appropriately.
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Affiliation(s)
- Arezou Teimouri
- Department of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, Canada; (L.V.M.); (S.N.S.); (A.D.)
- Correspondence:
| | - Laura V. Minard
- Department of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, Canada; (L.V.M.); (S.N.S.); (A.D.)
| | - Samantha N. Scott
- Department of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, Canada; (L.V.M.); (S.N.S.); (A.D.)
| | - Amanda Daniels
- Department of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, Canada; (L.V.M.); (S.N.S.); (A.D.)
| | - Stephanie Snow
- QEII Health Sciences Centre, Division of Medical Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
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8
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Apalla Z, Rapoport B, Sibaud V. Dermatologic immune-related adverse events: The toxicity spectrum and recommendations for management. Int J Womens Dermatol 2022; 7:625-635. [PMID: 35005180 PMCID: PMC8721136 DOI: 10.1016/j.ijwd.2021.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 01/15/2023] Open
Abstract
Immune checkpoint inhibitors are a new class of oncologic drugs that act via the inhibition of checkpoints, thereby unlocking the immune system to attack cancer cells. Their emergence has radically changed the concept of therapy in oncologic patients. However, despite their overall favorable profile, their use has been associated with specific toxicities that may potentially affect treatment. The so-called immune-related adverse events (irAEs) mostly correspond to dysimmune reactions that can affect nearly every organ system, in theory, notably with the development of colitis, hepatitis, pneumonitis, or thyroiditis. Dermatologic irAEs are also among the most common, reaching a rate of approximately 40%. They are characterized by a wide phenotypic range, including mainly eczematous or lichenoid rashes, psoriasis, or autoimmune bullous disorders. Pruritus may accompany the aforementioned rashes or develop as an isolated symptom without the presence of skin changes. Depigmentation and hair/nail changes can be also observed in association with immune checkpoint inhibitor treatment. In the current article, we present an overview of the clinical spectrum of irAEs and provide tips for early recognition and management of dermatologic irAEs. We highlight the role that dermatologists can play in relieving patients and allowing for oncologic treatment to be maintained and administered more safely.
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Affiliation(s)
- Zoe Apalla
- Second Dermatology Department, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Bernardo Rapoport
- Immunology Department, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
| | - Vincent Sibaud
- Oncodermatology Department, Cancer University Institute, Toulouse Oncopole, France
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9
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Halle BR, Betof Warner A, Zaman FY, Haydon A, Bhave P, Dewan AK, Ye F, Irlmeier R, Mehta P, Kurtansky NR, Lacouture ME, Hassel JC, Choi JS, Sosman JA, Chandra S, Otto TS, Sullivan R, Mooradian MJ, Chen ST, Dimitriou F, Long G, Carlino M, Menzies A, Johnson DB, Rotemberg VM. Immune checkpoint inhibitors in patients with pre-existing psoriasis: safety and efficacy. J Immunother Cancer 2021; 9:jitc-2021-003066. [PMID: 34635495 PMCID: PMC8506877 DOI: 10.1136/jitc-2021-003066] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/14/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are approved to treat multiple cancers. Retrospective analyses demonstrate acceptable safety of ICIs in most patients with autoimmune disease, although disease exacerbation may occur. Psoriasis vulgaris is a common, immune-mediated disease, and outcomes of ICI treatment in patients with psoriasis are not well described. Thus we sought to define the safety profile and effectiveness of ICIs in patients with pre-existing psoriasis. Methods In this retrospective cohort study, patients from eight academic centers with pre-existing psoriasis who received ICI treatment for cancer were evaluated. Main safety outcomes were psoriasis exacerbation and immune-related adverse events (irAEs). We also assessed progression-free survival (PFS) and overall survival. Results Of 76 patients studied (50 (66%) male; median age 67 years; 62 (82%) with melanoma, 5 (7%) with lung cancer, 2 (3%) with head and neck cancer, and 7 (9%) with other cancers; median follow-up 25.1 months (range=0.2–99 months)), 51 (67%) received anti-PD-1 antibodies, 8 (11%) anti-CTLA-4, and 17 (22%) combination of anti-PD-1/CTLA-4. All patients had pre-existing psoriasis, most frequently plaque psoriasis (46 patients (61%)) and 15 (20%) with psoriatic arthritis. Forty-one patients (54%) had received any prior therapy for psoriasis although only two (3%) were on systemic immunosuppression at ICI initiation. With ICI treatment, 43 patients (57%) experienced a psoriasis flare of cutaneous and/or extracutaneous disease after a median of 44 days of receiving ICI. Of those who experienced a flare, 23 patients (53%) were managed with topical therapy only; 16 (21%) needed systemic therapy. Only five patients (7%) required immunotherapy discontinuation for psoriasis flare. Forty-five patients (59%) experienced other irAEs, 17 (22%) of which were grade 3/4. PFS with landmark analysis was significantly longer in patients with a psoriasis flare versus those without (39 vs 8.7 months, p=0.049). Conclusions In this multicenter study, ICI therapy was associated with frequent psoriasis exacerbation, although flares were manageable with standard psoriasis treatments and few required ICI discontinuation. Patients who experienced disease exacerbation performed at least as well as those who did not. Thus, pre-existing psoriasis should not prevent patients from receiving ICIs for treatment of malignancy.
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Affiliation(s)
| | | | | | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Prachi Bhave
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paras Mehta
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Jessica C Hassel
- Department of Dermatology, NCT, University Hospital Heidelberg, Heidelberg, Germany
| | - Jacob S Choi
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey A Sosman
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sunandana Chandra
- Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tracey S Otto
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.,Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Meghan J Mooradian
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Florentia Dimitriou
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Georgina Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matteo Carlino
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Westmead Hospital, Westmead, New South Wales, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Douglas B Johnson
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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10
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Dreno B, Amici JM, Demessant-Flavigny AL, Wright C, Taieb C, Desai SR, Alexis A. The Impact of Acne, Atopic Dermatitis, Skin Toxicities and Scars on Quality of Life and the Importance of a Holistic Treatment Approach. Clin Cosmet Investig Dermatol 2021; 14:623-632. [PMID: 34163201 PMCID: PMC8213955 DOI: 10.2147/ccid.s315846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/15/2021] [Indexed: 01/15/2023]
Abstract
Skin conditions such as acne, atopic dermatitis, skin toxicity from oncology treatment, and scars are among the most common health conditions and negatively impact quality of life (QoL). Yet the physician perception of this impact often varies greatly from the patient perception. This is important because patient illness perception is closely linked with seeking help and treatment adherence behaviors. The objective of this review is to better understand the impact of these four highly prevalent skin conditions on QoL including their health-related economic factors to improve treatment outcomes. The literature search included literature published on QoL with acne, atopic dermatitis, scars (from any cause) and skin toxicities on PubMed between 2015 and 2020. We found that patients with skin conditions have a much higher frequency of altered QoL and psychological distress than those without. Also, skin conditions negatively impact self-image and can cause feelings of isolation, loneliness, lower self-esteem, and lower body satisfaction. Additionally, physical discomfort adds to the psychological distress. These physical and psychological impacts are an enormous financial burden on patients, their families and society. We found evidence that holistic treatment including treating the skin condition itself, providing wider peer and psychological support as well as shared decision-making, therapeutic patient education and dermatologist involvement improves outcomes. Holistic history-taking, checklists, or the use of more formal QoL scoring tools can be incorporated into routine consultations to better assess patient well-being and provide clinicians with important information for adapting treatment to individual patient requirements. In conclusion, this review highlights the overall impact of skin conditions (including psychological and QoL impacts) and the importance of providing holistic care to optimize treatment outcomes. A comprehensive QoL screening tool would be useful to help provide patient-centered treatment.
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Affiliation(s)
- Brigitte Dreno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, Nantes University, Nantes, Pays de la Loire, France
| | - Jean Michel Amici
- Dermatology Department, Bordeaux University Hospital, Bordeaux, Nouvelle-Aquitaine, France
| | | | - Charlotte Wright
- Speak the Speech Consulting, Asnières-sur-Seine, Ile-de-France, France
| | - Charles Taieb
- Patients Priority Department, European Market Maintenance Assessment, Fontenay Sousbois, Ile-de-France, France
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center & Innovative Dermatology, Dallas, TX, USA
| | - Andrew Alexis
- Skin of Color Center, Mount Sinai St. Luke’s and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Thompson L, Li E, Krasnow N, Chang M, Said J, Molina G, Polyakov N, Yoon J, Dee E, Huang K, Blum A, Kuchroo J, Hinton A, Reynolds K, Chen S. Effect of dermatological consultation on survival in patients with checkpoint inhibitor‐associated cutaneous toxicity. Br J Dermatol 2021; 185:627-635. [DOI: 10.1111/bjd.20074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Affiliation(s)
- L.L. Thompson
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - E.B. Li
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - N.A. Krasnow
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - M.S. Chang
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - J.T. Said
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - G.E. Molina
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - N.J. Polyakov
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - J. Yoon
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - E.C. Dee
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - K. Huang
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - A.E. Blum
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - J.R. Kuchroo
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - A.N. Hinton
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - K.L. Reynolds
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - S.T. Chen
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
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12
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Hines A, Hazim A, Wetter DA, Bridges AG, Camilleri MJ, McEvoy MT, El-Azhary RA, Davis MDP, Sartori-Valinotti JC. Retrospective analysis of 578 inpatient dermatology consultations in hematology and hematopoietic stem cell transplant patients. Int J Dermatol 2021; 60:1385-1391. [PMID: 33991106 DOI: 10.1111/ijd.15650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hospitalized patients with hematologic malignancies are medically complex and commonly affected by dermatologic conditions. METHODS Retrospective chart review from January 1, 2014, to December 31, 2018, at Rochester Methodist Hospital (Rochester, Minnesota, USA). Patients hospitalized on hematology and BMT services receiving dermatology consultation were included. RESULTS In all, 578 consultations (63% male, median age 61 years) were reviewed. Drug reactions (22%), infection (17%), and malignant neoplasm (10%) accounted for nearly half of diagnoses. Exanthematous drug reaction (10%), graft-versus-host disease (7%), and lymphoma or leukemia cutis (6%) were the commonest individual diagnoses. There were significantly more drug reactions in severe neutropenia (33.2% vs. 15.0%), neutrophilic dermatoses in myeloid neoplasm (5.2% vs. 0.3%), and viral infection in lymphoid neoplasm (8.3% vs. 1.2%). Consultation frequently altered treatment (68%), diagnostic workup (63%), and the primary service's initial diagnostic impression (53%). Biopsies were performed in 52% of consultations and helped secure a diagnosis 73% of the time. A total of 16.4% of consultations did not receive a definitive final diagnosis, and 18.5% were resolved in one visit. CONCLUSION This is the largest study to date of hospital dermatology consultation in hematology patients. Biopsies are utilized frequently and are diagnostically useful. The complexity of this patient population is evidenced by the fact that a final diagnosis remains elusive in a number of cases despite the multiple visits required for the vast majority of consultations. Nevertheless, dermatology consultation alters diagnosis and treatment in the majority of patients, highlighting the critical role dermatologists have in the care of these patients.
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Affiliation(s)
- Alexander Hines
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antonious Hazim
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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13
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Kwong BY. Outcomes of Embedding Dermatologic Care Within Oncology Practices for Patients With Cancer. JAMA Dermatol 2021; 156:1051-1052. [PMID: 32609297 DOI: 10.1001/jamadermatol.2020.1794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
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14
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Supportive oncodermatology-a narrative review of its utility and the way forward. Support Care Cancer 2021; 29:4931-4937. [PMID: 33712911 DOI: 10.1007/s00520-021-06124-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/02/2021] [Indexed: 11/27/2022]
Abstract
Supportive oncodermatology is an interdisciplinary field, emerging due to increasing dermatological morbidity in patients with cancer and the recognition of the need for greater collaborative and integrated care to improve patient outcomes. These two unique fields (Oncology and Dermatology) may be integrated in various ways, such as through specialised combined clinics, protocols for expedited access, multidisciplinary groups and meetings, and the development of best practices guidelines. This narrative review consolidates the small but growing literature surrounding supportive oncodermatology; discusses the potential benefit and disadvantages, and areas for future research; and suggests a framework for implementation.
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15
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Barrios DM, Phillips GS, Geisler AN, Trelles SR, Markova A, Noor SJ, Quigley EA, Haliasos HC, Moy AP, Schram AM, Bromberg J, Funt SA, Voss MH, Drilon A, Hellmann MD, Comen EA, Narala S, Patel AB, Wetzel M, Jung JY, Leung DYM, Lacouture ME. IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies. Ann Oncol 2021; 32:736-745. [PMID: 33667669 PMCID: PMC9282165 DOI: 10.1016/j.annonc.2021.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Immunoglobulin E (IgE) blockade with omalizumab has demonstrated clinical benefit in pruritus-associated dermatoses (e.g. atopic dermatitis, bullous pemphigoid, urticaria). In oncology, pruritus-associated cutaneous adverse events (paCAEs) are frequent with immune checkpoint inhibitors (CPIs) and targeted anti-human epidermal growth factor receptor 2 (HER2) therapies. Thus, we sought to evaluate the efficacy and safety of IgE blockade with omalizumab in cancer patients with refractory paCAEs related to CPIs and anti-HER2 agents. Patients and methods: Patients included in this multicenter retrospective analysis received monthly subcutaneous injections of omalizumab for CPI or anti-HER2 therapy-related grade 2/3 pruritus that was refractory to topical corticosteroids plus at least one additional systemic intervention. To assess clinical response to omalizumab, we used the Common Terminology Criteria for Adverse Events version 5.0. The primary endpoint was defined as reduction in the severity of paCAEs to grade 1/0. Results: A total of 34 patients (50% female, median age 67.5 years) received omalizumab for cancer therapy-related paCAEs (71% CPIs; 29% anti-HER2). All had solid tumors (29% breast, 29% genitourinary, 15% lung, 26% other), and most (n = 18, 64%) presented with an urticarial phenotype. In total, 28 of 34 (82%) patients responded to omalizumab. The proportion of patients receiving oral corticosteroids as supportive treatment for management of paCAEs decreased with IgE blockade, from 50% to 9% (P < 0.001). Ten of 32 (31%) patients had interruption of oncologic therapy due to skin toxicity; four of six (67%) were successfully rechallenged following omalizumab. There were no reports of anaphylaxis or hypersensitivity reactions related to omalizumab. Conclusions: IgE blockade with omalizumab demonstrated clinical efficacy and was well tolerated in cancer patients with pruritus related to CPIs and anti-HER2 therapies.
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Affiliation(s)
- D M Barrios
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - G S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A N Geisler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - S R Trelles
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - S J Noor
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - E A Quigley
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - H C Haliasos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - A P Moy
- Department of Dermatology, Weill Cornell Medicine, New York, USA; Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A M Schram
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - J Bromberg
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - S A Funt
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - M H Voss
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - A Drilon
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - M D Hellmann
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - E A Comen
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - S Narala
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A B Patel
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Wetzel
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, USA
| | - J Y Jung
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, USA; Dermatology Service, Department of Medical Oncology, Norton Cancer Institute, Louisville, USA
| | - D Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA.
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16
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Yang JJ, So N, Maloney NJ, Arzeno J, Clifton KK, Bach DQ. Inadequate and delayed characterization of cutaneous reactions for US Food and Drug Administration-approved oncologic drugs from 2011-2020 leading to medication discontinuation. J Am Acad Dermatol 2020; 85:1351-1352. [PMID: 33236990 DOI: 10.1016/j.jaad.2020.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/13/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jason J Yang
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Naomi So
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Nolan J Maloney
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Julia Arzeno
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Katherine K Clifton
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Daniel Q Bach
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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17
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Barrios DM, Phillips GS, Freites-Martinez A, Hsu M, Ciccolini K, Skripnik Lucas A, Marchetti MA, Rossi AM, Lee EH, Deng L, Markova A, Myskowski PL, Lacouture ME. Outpatient dermatology consultations for oncology patients with acute dermatologic adverse events impact anticancer therapy interruption: a retrospective study. J Eur Acad Dermatol Venereol 2020; 34:1340-1347. [PMID: 31856311 DOI: 10.1111/jdv.16159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dermatologic adverse events (dAEs) of anticancer therapies may negatively impact dosing and quality of life. While therapy interruption patterns due to dAEs have been studied in hospitalized cancer patients, similar outcomes in outpatient oncodermatology are lacking. OBJECTIVES To analyse the therapy interruption patterns, clinico-histopathologic characteristics and management outcomes of outpatient dermatology consultations for acute dAEs attributed to the most frequently interrupted class of oncologic agents. METHODS We performed a retrospective cohort study of all cancer patients who received a same-day outpatient dermatology consultation for acute dAEs at our institution from 1 January to 30 June 2015. Relevant data were abstracted from electronic medical records, including demographics, oncologic history and explicit recommendations by both the referring clinician and consulting dermatologist on anticancer therapy interruption. Consultations with the most frequently interrupted class of oncologic treatment were characterized according to clinico-histopathologic features, dermatologic management and clinical outcomes. RESULTS There were 426 same-day outpatient dermatology consultations (median age 59, 60% female, 30% breast cancer), of which 295 (69%) had systemic anticancer therapy administered within 30 days prior. There was weak inter-rater agreement between referring clinicians and consulting dermatologists on interruption of anticancer treatment (n = 150, κ = 0.096; 95% CI -0.02 to 0.21). Seventy-three (25%) consultations involved interruption by the referring clinician, most commonly targeted therapy (24, 33%). Maculopapular rash was commonly observed in 23 consultations with 25 dAEs attributed to targeted agents (48%), and topical corticosteroids were most frequently utilized for management (22, 38%). The majority (83%) of consultations with targeted therapy-induced dAEs responded to dermatologic treatment and 84% resumed oncologic therapy, although three (19%) at a reduced dose. Rash recurred only in two instances (13%). CONCLUSIONS A high frequency of positive outcomes in the management of targeted therapy-induced dAEs by outpatient consulting dermatologists and low recurrence of skin toxicity suggests impactful reductions in interruption of anticancer therapy.
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Affiliation(s)
- D M Barrios
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,SUNY Upstate Medical University, Syracuse, NY, USA
| | - G S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - A Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Ciccolini
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Skripnik Lucas
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E H Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - L Deng
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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