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Park JH, Yoon D, Lee J, Oh SJ, Kim HJ, Lee JH, Lee DY. Clinical profile of cutaneous adverse events of immune checkpoint inhibitors in a single tertiary center. J Dermatol 2021; 48:979-988. [PMID: 33878219 DOI: 10.1111/1346-8138.15824] [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: 10/13/2020] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 01/23/2023]
Abstract
Programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have demonstrated their efficacy in the treatment of various malignancies. Despite their benefits, their immunomodulatory activities can cause unpredictable cutaneous adverse events (CAE). This study aimed to identify characteristics of CAE in patients treated with PD-1/PD-L1 inhibitors through the medical records, photographs, and pathology reports. Fifty CAE occurred in 47 (2.75%) of 1711 patients treated with PD-1/PD-L1 inhibitors. Pruritic, psoriasiform, urticarial, and acneiform eruptions were the four most common types. Melanoma patients showed CAE more frequently than other malignancies. Acneiform eruption occurred more often at ages under 60 years. Urticarial eruption appeared earlier, while keratoacanthoma appeared later after immunotherapy. The overall survival times were not significantly different between the two groups with and without CAE by Kaplan-Meier analysis (p = 0.055). Studies on CAE may provide more information to understand these drugs and to help manage the patients.
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Affiliation(s)
- Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dokyoung Yoon
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Je Kim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Amagai R, Fujimura T, Kambayashi Y, Sato Y, Tanita K, Ohuchi K, Hashimoto A, Aiba S. Severe pyrexia from nivolumab-resistant advanced melanoma after successful combined therapy with encorafenib plus binimetinib. J Dermatol 2020; 47:654-657. [PMID: 32293049 DOI: 10.1111/1346-8138.15346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/13/2020] [Indexed: 01/26/2023]
Abstract
Various serious adverse events (AE) have been reported to occur at a high rate in patients treated with BRAF plus mitogen-activated protein kinase kinase (MEK) inhibitor combination therapy, but their subtypes differ among the BRAF/MEK inhibitors. Pyrexia or a spike of fever are well-known AE of BRAF inhibitors, with or without MEK inhibitors, and have been reported to have a high incidence after dabrafenib/trametinib, but not after encorafenib/binimetinib. In this report, we describe three cases of severe pyrexia in nivolumab-resistant advanced melanoma after successful combined therapy with encorafenib plus binimetinib. Interestingly, in all cases, the serum levels of soluble CD163 C-X-C motif chemokine (CXCL)9, CXCL10 and CXCL11, which are known biomarkers for adult-onset Still's disease (AOSD), increased in parallel with the development of pyrexia. Our present cases suggest that pyrexia caused by BRAF/MEK inhibitors may possess a similar pathophysiology as that of AOSD.
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Affiliation(s)
- Ryo Amagai
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yota Sato
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kayo Tanita
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Ohuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Fujimura T, Fujisawa Y, Kambayashi Y, Aiba S. Significance of BRAF Kinase Inhibitors for Melanoma Treatment: From Bench to Bedside. Cancers (Basel) 2019; 11:cancers11091342. [PMID: 31514399 PMCID: PMC6770075 DOI: 10.3390/cancers11091342] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/10/2023] Open
Abstract
According to clinical trials, BRAF kinase inhibitors in combination with MEK kinase inhibitors are among the most promising chemotherapy regimens for the treatment of advanced BRAF-mutant melanoma, though the rate of BRAF mutation gene-bearing cutaneous melanoma is limited, especially in the Asian population. In addition, drug resistance sometimes abrogates the persistent efficacy of combined therapy with BRAF and MEK inhibitors. Therefore, recent pre-clinical study-based clinical trials have attempted to identify optimal drugs (e.g., immune checkpoint inhibitors or histone deacetylase (HDAC) inhibitors) that improve the anti-melanoma effects of BRAF and MEK inhibitors. In addition, the development of novel protocols to avoid resistance of BRAF inhibitors is another purpose of recent pre-clinical and early clinical trials. This review focuses on pre-clinical studies and early to phase III clinical trials to discuss the development of combined therapy based on BRAF inhibitors for BRAF-mutant advanced melanoma, as well as mechanisms of resistance to BRAF inhibitors.
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Affiliation(s)
- Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
| | - Yasuhiro Fujisawa
- Department of Dermatology, University of Tsukuba, Tsukuba 305-8576, Japan.
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
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Amagai R, Fujimura T, Kambayashi Y, Sato Y, Tanita K, Hashimoto A, Aiba S. Three cases of nivolumab therapy‐failed advanced melanoma successfully controlled by ipilimumab with intensity‐modulated radiotherapy. J Dermatol 2019; 46:449-452. [DOI: 10.1111/1346-8138.14861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Ryo Amagai
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - Taku Fujimura
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - Yumi Kambayashi
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - Yota Sato
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - Kayo Tanita
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - Akira Hashimoto
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
| | - Setsuya Aiba
- Department of Dermatology Tohoku University Graduate School of Medicine Sendai Japan
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Fujimura T, Hidaka T, Kambayashi Y, Aiba S. BRAF kinase inhibitors for treatment of melanoma: developments from early-stage animal studies to Phase II clinical trials. Expert Opin Investig Drugs 2018; 28:143-148. [PMID: 30556435 DOI: 10.1080/13543784.2019.1558442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Approximately, 30.4-66.0% of cutaneous melanomas possess a mutation in the BRAF gene that activates downstream signaling through the mitogen-activated protein (MAP) kinase pathway; this provides an attractive target for the treatment of advanced melanoma. Although BRAF inhibitors rapidly suppress melanoma growth, median progression-free survival remains unsatisfactory. Recent clinical trials have investigated drugs that can optimally enhance and prolong the anti-melanoma effects of BRAF inhibitors. AREAS COVERED This review discusses the development of BRAF inhibitor-based combination therapies for BRAF-mutant advanced melanoma. EXPERT OPINION Future strategies for the treatment of advanced melanoma include novel combination therapies using BRAF/MEK inhibitors and immune checkpoints inhibitors or histone deacetylase inhibitors. These combination therapies might enhance antitumor responses against melanoma, prolonging survival in advanced melanoma patients. Further clinical studies are needed to optimize these novel combination therapies.
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Affiliation(s)
- Taku Fujimura
- a Department of Dermatology , Tohoku University Graduate School of Medicine , Aoba-ku, Sendai , Japan
| | - Takanori Hidaka
- a Department of Dermatology , Tohoku University Graduate School of Medicine , Aoba-ku, Sendai , Japan
| | - Yumi Kambayashi
- a Department of Dermatology , Tohoku University Graduate School of Medicine , Aoba-ku, Sendai , Japan
| | - Setsuya Aiba
- a Department of Dermatology , Tohoku University Graduate School of Medicine , Aoba-ku, Sendai , Japan
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Sato Y, Fujimura T, Kambayashi Y, Tanita K, Tono H, Hashimoto A, Aiba S. Two cases of dabrafenib and trametinib therapy-failed advanced melanoma successfully controlled by nivolumab monotherapy. J Dermatol 2018; 45:1105-1108. [DOI: 10.1111/1346-8138.14508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Yota Sato
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Taku Fujimura
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yumi Kambayashi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Kayo Tanita
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hisayuki Tono
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Akira Hashimoto
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Setsuya Aiba
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
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Abstract
PURPOSE OF REVIEW Prognosis of patients with advanced melanoma is dismal with a median overall survival of about 8 months and 5-year overall survival from a diagnosis of metastatic disease of roughly 10%. However, immune checkpoint inhibitors have brought indispensable benefits to melanoma patients. Here we will review the recent clinical efficacy and adverse events of immune checkpoint inhibitors for melanoma patients. RECENT FINDINGS The immune checkpoint inhibitors increase confirmed objective response and prolong progression-free and overall survival of the afflicted patients in association with maintaining their quality of life. Although diverse immune-related adverse events occur, most of them are manageable by appropriate immunomodulating agents. Clinical efficacy of immune checkpoint inhibitors continues even after discontinuation of drugs. Compared with conventional therapeutic options, the immune checkpoint inhibitors appear to prolong the survival of patients with advanced melanoma. Further clinical trials are warranted to determine whether their combinatory use with other treatment options may augment benefits or not.
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Fujimura T, Kambayashi Y, Hidaka T, Tamabuchi E, Otake E, Tono H, Mizuashi M, Furudate S, Aiba S. Severe erythema exudative multiforme developing from advanced melanoma treated with dabrafenib and trametinib followed by nivolumab. J Dermatol 2017; 45:e35-e36. [DOI: 10.1111/1346-8138.14085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Taku Fujimura
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yumi Kambayashi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Takanori Hidaka
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Erika Tamabuchi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Eika Otake
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hisayuki Tono
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Masato Mizuashi
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Sadanori Furudate
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Setsuya Aiba
- Department of Dermatology; Tohoku University Graduate School of Medicine; Sendai Japan
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