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Parriel E, Sibaud V. Supportive oncodermatology is the key! J Eur Acad Dermatol Venereol 2024; 38:1675-1676. [PMID: 39177318 DOI: 10.1111/jdv.20228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 08/24/2024]
Affiliation(s)
- E Parriel
- Oncodermatology, Institut Universitaire du Cancer - Oncopole, Toulouse, France
| | - V Sibaud
- Oncodermatology, Institut Universitaire du Cancer - Oncopole, Toulouse, France
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2
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Pinto-Pulido EL, Polo-Rodríguez I, González-Cañete M, Medina-Expósito I, Vélez-Velázquez MD, Medina-Montalvo S. Association of bullous pemphigoid and Grover disease induced by immune checkpoint therapy. An Bras Dermatol 2024; 99:775-777. [PMID: 38876966 PMCID: PMC11342969 DOI: 10.1016/j.abd.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 06/16/2024] Open
Affiliation(s)
- Elena Lucía Pinto-Pulido
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain.
| | - Isabel Polo-Rodríguez
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain
| | - Marta González-Cañete
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain
| | - Ileana Medina-Expósito
- Department of Pathology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain
| | | | - Susana Medina-Montalvo
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain
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3
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Dimitriou F, Cheng PF, Saltari A, Schaper-Gerhardt K, Staeger R, Haunerdinger V, Sella F, Tastanova A, Urban C, Dettwiler S, Mihic-Probst D, Matter CM, Michielin O, Gutzmer R, Long GV, Becher B, Levesque MP, Dummer R. A targetable type III immune response with increase of IL-17A expressing CD4 + T cells is associated with immunotherapy-induced toxicity in melanoma. NATURE CANCER 2024:10.1038/s43018-024-00810-4. [PMID: 39210005 DOI: 10.1038/s43018-024-00810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
Immune checkpoint inhibitors are standard-of-care for the treatment of advanced melanoma, but their use is limited by immune-related adverse events. Proteomic analyses and multiplex cytokine and chemokine assays from serum at baseline and at the adverse event onset indicated aberrant T cell activity with differential expression of type I and III immune signatures. This was in line with the finding of an increase in the proportion of CD4+ T cells with IL-17A expression at the adverse event onset in the peripheral blood using flow cytometry. Multiplex immunohistochemistry and spatial transcriptomics on immunotherapy-induced skin rash and colitis showed an increase in the proportion of CD4+ T cells with IL-17A expression. Anti-IL-17A was administered in two patients with mild myocarditis, colitis and skin rash with resolution of the adverse events. This study highlights the potential role of type III CD4+ T cells in adverse event development and provides proof-of-principle evidence for a clinical trial using anti-IL-17A for treating adverse events.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Phil F Cheng
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Annalisa Saltari
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Katrin Schaper-Gerhardt
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
- Department of Dermatology, Medical School Hannover, Hannover, Germany
| | - Ramon Staeger
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Veronika Haunerdinger
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Federica Sella
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Aizhan Tastanova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian Urban
- Functional Genomics Center Zurich, University of Zurich/ETH Zurich, Zurich, Switzerland
| | - Susanne Dettwiler
- Institute for Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Daniela Mihic-Probst
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Institute for Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center and Center for Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Olivier Michielin
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich (UZH), Zurich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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4
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Juan-Carpena G, Martínez-Banaclocha N, Palazón-Cabanes JC, Niveiro-de Jaime M, Betlloch-Mas I, Blanes-Martínez M. Cutaneous immune-related adverse events: incidence rates, risk factors and association with extracutaneous toxicity - a prospective study of 189 patients treated with checkpoint inhibitors at a Spanish tertiary care hospital. Clin Exp Dermatol 2024; 49:991-1001. [PMID: 38372424 DOI: 10.1093/ced/llae060] [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: 12/10/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Clinicians are increasingly prescribing immune checkpoint inhibitors (ICIs) to treat cancer, but the real-world incidence, characteristics and risk factors of cutaneous immune-related adverse events (cirAEs) are unclear. OBJECTIVES To determine the incidence, features and risk factors of cirAEs and to measure their possible association with extracutaneous toxicity. METHODS We conducted a prospective observational study in a Spanish tertiary care hospital, including people who started an ICI between March 2020 and May 2022. We used a survival analysis and a log-rank test to obtain and compare incidence rates, and a multivariate Cox model to detect risk factors for cirAEs. RESULTS We included 189 patients, 82 (43.4%) of whom presented cutaneous toxicity. The incidence of cirAEs was 75.0 per 100 person-years, with a 50.0% probability of the appearance of a cirAE at 10 months of follow-up. The most frequent cirAE category was inflammatory dermatoses, and the most frequent types were pruritus, eczema and maculopapular eruptions. ICI combination therapy, a family history of psoriasis and rheumatological and pulmonary immune-related adverse events increased the risk of cirAEs. CONCLUSIONS We found a high incidence of cirAEs, and they occurred early in the follow-up period. Dermatologists should be involved in the management of cirAEs, especially in people with risk factors.
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Affiliation(s)
- Gloria Juan-Carpena
- Department of Dermatology, Morales Meseguer University Hospital, Murcia, Spain
- Toxirel Investigation Group, Alicante, Spain
| | - Natividad Martínez-Banaclocha
- Toxirel Investigation Group, Alicante, Spain
- Department of Oncology, Dr. Balmis University General Hospital, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - María Niveiro-de Jaime
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Pathology, Dr. Balmis University General Hospital, Alicante, Spain
| | - Isabel Betlloch-Mas
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Dermatology, Dr. Balmis University General Hospital, Alicante, Spain
- Miguel Hernández University of Elche, Alicante, Spain
| | - Mar Blanes-Martínez
- Toxirel Investigation Group, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Dermatology, Dr. Balmis University General Hospital, Alicante, Spain
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5
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Fattore D, Lauletta G, Apalla Z, Sibaud V, Freites-Martinez A. Dermatologic immune-related adverse events: It is time for a game change! J Eur Acad Dermatol Venereol 2024. [PMID: 39096035 DOI: 10.1111/jdv.20282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Lauletta
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Zoe Apalla
- Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Vincent Sibaud
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
| | - Azael Freites-Martinez
- Oncodermatology Clinic, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
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6
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Trefzer LK, Pilz AC, Eyerich K. Dermatologische unerwünschte Arzneimittelwirkungen bei Behandlung mit Biologika – Pathogenese und Management. J Dtsch Dermatol Ges 2024; 22:1126-1137. [PMID: 39105241 DOI: 10.1111/ddg.15360_g] [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: 02/23/2023] [Accepted: 01/06/2024] [Indexed: 08/07/2024]
Abstract
ZusammenfassungBiologika sind für verschiedene Entzündungskrankheiten aus Dermatologie, Allergologie, Rheumatologie und Gastroenterologie sowie für zahlreiche maligne Erkrankungen zugelassen. Dermatologische unerwünschte Arzneimittelwirkungen durch Biologika können primären entzündlichen Dermatosen ähneln, unterscheiden sich von ihnen jedoch in ihrer Pathogenese. In diesem Artikel beschreiben wir die fünf verschiedenen Pathomechanismen dermatologischer, unerwünschter Arzneimittelwirkungen durch Biologika. Durch besseres Verständnis dieser Mechanismen erhoffen wir uns wertvolle Einblicke in die Pathogenese primärer Entzündungskrankheiten zu gewinnen. Außerdem geben wir in diesem Artikel Empfehlungen für die Behandlung und das Management der durch Biologika ausgelösten dermatologischen unerwünschten Arzneimittelwirkungen.
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Affiliation(s)
- Laura Katharina Trefzer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät der Universität Freiburg, Freiburg, Deutschland
| | - Anna Caroline Pilz
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät der Universität Freiburg, Freiburg, Deutschland
| | - Kilian Eyerich
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät der Universität Freiburg, Freiburg, Deutschland
- Karolinska Institutet und Karolinska Universitätsklinikum, Stockholm, Schweden
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
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7
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Trefzer LK, Pilz AC, Eyerich K. Dermatologic adverse events caused by biologic treatments - Pathogenesis and management. J Dtsch Dermatol Ges 2024; 22:1126-1136. [PMID: 38923669 DOI: 10.1111/ddg.15360] [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: 02/23/2023] [Accepted: 01/06/2024] [Indexed: 06/28/2024]
Abstract
Biologics are approved for various dermatologic, allergic, rheumatic, and gastroenterologic inflammatory diseases, as well as for numerous malignancies. The dermatologic adverse events from treatment with biologics may resemble primary inflammatory diseases but differ in pathogenesis. In this article, we describe five different pathogenic mechanisms of dermatologic adverse events. By studying these mechanisms, we hope to gain valuable insights into the pathogenesis of primary inflammatory diseases. In addition, in this article, we provide recommendations for the treatment and management of the dermatological adverse events induced by biologics.
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Affiliation(s)
- Laura Katharina Trefzer
- Department of Dermatology and Venerology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Caroline Pilz
- Department of Dermatology and Venerology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kilian Eyerich
- Department of Dermatology and Venerology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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8
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Al-Eryani K, Epstein JB, Monreal AV, Villa A. Orofacial complications from immune checkpoint inhibitors: A retrospective analysis from two academic medical centers. Head Neck 2024; 46:1865-1872. [PMID: 38258988 DOI: 10.1002/hed.27646] [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: 11/04/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are FDA-approved for various cancers, yet their orofacial immune-related adverse events (irAEs) remain poorly understood. Our two-center retrospective study aims to better understand the prevalence and nature of these orofacial irAEs. METHODS We retrospectively collected demographics, ICI details, and onset of orofacial irAEs in ICI-treated patients at University of California San Francisco and City of Hope (2013-2021). Orofacial irAEs were identified by ICD-10 codes and data categorized as dry mouth/xerostomia, oral mucosal lesions, and orofacial neuropathies. Patients with pre-existing orofacial conditions resembling the reported irAEs were excluded. RESULTS Among 3768 ICI-treated patients, 408 (10.8%) developed 467 orofacial irAEs: oral mucosal diseases (41.4%), dry mouth/xerostomia (41.0%), and orofacial neuropathies (17.6%). Notably, head and neck cancers had the highest incidence of orofacial irAEs. CONCLUSIONS Orofacial irAEs are relatively common in patients receiving ICIs, necessitating careful monitoring and management of these complications during and after the treatment.
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Affiliation(s)
- Kamal Al-Eryani
- Department of Orofacial Sciences, University of California, San Francisco, California, USA
| | - Joel B Epstein
- Dental Oncology Services, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Cedars Sinai Health System, Los Angeles, California, USA
| | - Anette Vistoso Monreal
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California, San Francisco, California, USA
- Oral Medicine, Oral Oncology and Dentistry, Miami Cancer Institute, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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9
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Salah S, Kerob D, Pages Laurent C, Lacouture M, Sibaud V. Evaluation of anticancer therapy-related dermatologic adverse events: Insights from Food and Drug Administration's Adverse Event Reporting System dataset. J Am Acad Dermatol 2024:S0190-9622(24)02532-5. [PMID: 39038557 DOI: 10.1016/j.jaad.2024.07.1456] [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: 04/03/2024] [Revised: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND New anticancer therapies have improved patient outcomes but associated dermatologic adverse events (AEs) may cause morbidity and treatment discontinuation. A comprehensive estimation of associations between cancer drugs and skin AEs is lacking. METHODS This study utilized the Food and Drug Administartion (FDA)'s Adverse Event Reporting System database (January 2013-September 2022), with 3,399,830 reports involving 3084 drugs and 16,348 AEs. A nearest neighbor matching model was employed to select 10 controls for each case report, utilizing the cosine similarity of demographic and AE severity factors to minimize false positives/negatives. RESULTS There were 10,698 unique anticancer drugs (n = 212) to skin AE (n = 873) pairs, of which 676 had significant reporting odds ratios (ROR) > 1, comprising 113 drugs and 144 AEs. The minimum ROR was 1.25, and 50% of associations displayed a ROR >10. The most common were rash (51 agents) and dry skin (28 drugs). Methotrexate induced the most distinct AEs (34), then mechlorethamine (33), and vemurafenib (24). Targeted therapies accounted for 49% of pairs, cytotoxic chemotherapies for 35.9%, and immunotherapies for 11%. CONCLUSIONS A total of 113 anticancer drugs were identified as significantly associated with skin AEs, most frequently rash and dry skin. Data are likely under-reported but enable quick postmarketing identification of skin toxicity signals.
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Affiliation(s)
- Samir Salah
- La Roche-Posay Laboratoire Dermatologique, Levallois Perret, France.
| | - Delphine Kerob
- La Roche-Posay Laboratoire Dermatologique, Levallois Perret, France
| | - Cecile Pages Laurent
- Departments of Oncodermatology and Clinical Research, Institut Universitaire du Cancer, Toulouse Oncopole, France
| | - Mario Lacouture
- Department of Medicine, New York University Langone, New York, New York
| | - Vincent Sibaud
- Departments of Oncodermatology and Clinical Research, Institut Universitaire du Cancer, Toulouse Oncopole, France
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10
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Esen BH, Özbek L, Oğuz S, Selçukbiricik F. Characterizing immune checkpoint inhibitor-related cutaneous adverse reactions: A comprehensive analysis of FDA adverse event reporting system (FAERS) database. Heliyon 2024; 10:e33765. [PMID: 39071598 PMCID: PMC11283008 DOI: 10.1016/j.heliyon.2024.e33765] [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: 10/18/2023] [Revised: 06/06/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background The increasing adoption of immune checkpoint inhibitors (ICIs) in clinical settings highlights their efficacy in treating diverse conditions, while also emphasizing the potential for common cutaneous adverse reactions to arise. The aim of this study is to investigate a multitude of impacting factors and determinants among patients presenting with ICI-associated cutaneous adverse reactions. Methods We conducted a comprehensive analysis of ICI-associated cutaneous adverse reactions using data from the FAERS. Our study spans from January 1, 2015, to March 31, 2023, focusing on ICIs, including anti-PD-1, anti-PD-L1, and anti-CTLA-4 agents. Findings Among the 334,293 reported irAR, 17,431 were identified as cutaneous adverse reactions (ARs). Predominant cutaneous ARs included rash (21.01 %), pruritus (11.22 %), and pemphigoid (3.90 %). Stevens-Johnson syndrome emerged as the most reported severe cutaneous adverse reaction (SCAR) (2.08 %). Anti-CTLA-4 agents exhibited higher cutaneous toxicity compared to anti-PD-1 and anti-PD-L1 agents. Anti-PD-1 agents demonstrated an elevated mortality rate. The combined use of ICIs with chemotherapy amplified the risk of SCAR and mortality. Targeted therapy was a risk factor for cutaneous ARs but was associated with reduced mortality. The median onset day for cutaneous toxicity was 21 days, while for SCAR, it was 23 days. Weight and age were identified as predictors of SCAR, cutaneous toxicity, and mortality. Skin cancer increased skin toxicity, while lung cancer heightened SCAR formation. The number of administered ICIs positively correlated with SCAR, skin toxicity, and mortality. Interpretation This study highlights the significance of early identification and effective management of cutaneous toxicities, along with personalized follow-up care, as essential strategies for minimizing risks and preventing treatment disruptions.
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Affiliation(s)
| | - Laşin Özbek
- Koç University, School of Medicine, İstanbul, Turkey
| | - Sinem Oğuz
- Koç University, School of Medicine, İstanbul, Turkey
| | - Fatih Selçukbiricik
- Koç University, School of Medicine, İstanbul, Turkey
- Koç University Hospital, Department of Medical Oncology, İstanbul, Turkey
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11
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Pach J, Valido K, Belzer A, Leventhal JS. The Use of Biologic Agents for the Treatment of Cutaneous Immune-Related Adverse Events from Immune Checkpoint Inhibitors: A Review of Reported Cases. Am J Clin Dermatol 2024; 25:595-607. [PMID: 38767827 DOI: 10.1007/s40257-024-00866-z] [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: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Cutaneous immune-related adverse events encompass a spectrum of dermatological manifestations, including lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus, vitiligo, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome. The conventional approach to treating high-grade or refractory cutaneous immune-related adverse events has involved high-dose systemic corticosteroids. However, their use is limited owing to the potential disruption of antitumor responses and associated complications. To address this, corticosteroid-sparing targeted immunomodulators have been explored as therapeutic alternatives. Biologic agents, commonly employed for non-cutaneous immune-related adverse events such as colitis, are increasingly recognized for their efficacy in treating various patterns of cutaneous immune-related adverse events, including psoriasiform, immunobullous, and Stevens-Johnson syndrome-like reactions. This review consolidates findings from the English-language literature, highlighting the use of biologic agents in managing diverse cutaneous immune-related adverse event patterns, also encompassing maculopapular, eczematous, and lichenoid eruptions, pruritus, and transient acantholytic dermatosis (Grover disease). Despite the established efficacy of these agents, further research is necessary to explore their long-term effects on antitumor responses.
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Affiliation(s)
- Jolanta Pach
- Yale University School of Medicine, New Haven, CT, USA
| | - Kailyn Valido
- Yale University School of Medicine, New Haven, CT, USA
| | - Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan S Leventhal
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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12
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Meier-Schiesser B, Zecha C, Zierold S, Kolm I, Röckel M, Fröhlich W, Mittag N, Schmitt C, Kumbrink J, Hassel JC, Berking C, Nashan D, French LE, Vera-González J, Dummer R, Kerl-French K, Heinzerling L. Checkpoint inhibitor-induced lichen planus differs from spontaneous lichen planus on the clinical, histological, and gene expression level. JAAD Int 2024; 15:157-164. [PMID: 38882039 PMCID: PMC11180371 DOI: 10.1016/j.jdin.2023.11.013] [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] [Accepted: 11/22/2023] [Indexed: 06/18/2024] Open
Abstract
Background Although highly efficacious, immune checkpoint inhibitors induce a multitude of immune-related adverse events including lichenoid skin reactions (irLP) that are often therapy-resistant. Objectives To compare the clinical, histological, and transcriptional features of irLP with spontaneous lichen planus (LP). Methods Clinical and histological presentations of irLP and LP, as well as the gene expression profiles of irLP and LP lesional and healthy skin were assessed. Results irLP differed considerably from LP with regard to the distribution pattern of skin lesions with irLP appearing mostly in an exanthematous form, whereas lesions were more localized in the LP group. Histologically, dermal lymphocyte infiltration was significantly lower in irLP compared with LP, whereas lymphocyte exocytosis and apoptotic keratinocytes were significantly higher in irLP. Gene expression analysis revealed irLP to have a more inflammatory profile with elevated IFNG levels and a possible role of phagosome signaling compared with LP. Limitations The study is descriptive and necessitates further investigation with larger cohorts and broader analyses. Conclusion irLP differs from spontaneous LP on the clinical, histopathological, and gene expression level. The inflammatory gene signature in irLP suggests that topical JAK inhibitors could be an effective treatment, targeting local skin inflammation without systemic immunosuppression.
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Affiliation(s)
| | - Christine Zecha
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Sarah Zierold
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Magdalena Röckel
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Waltraud Fröhlich
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Nora Mittag
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christina Schmitt
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Joerg Kumbrink
- Institute of Pathology, Faculty of Medicine, Ludwig Maximilian University Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Dorothee Nashan
- Department of Dermatology, Hospital Dortmund, Dortmund, Germany
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Julio Vera-González
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Katrin Kerl-French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Lucie Heinzerling
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
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13
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Kraehenbuehl L, Wolchok JD, Merghoub T, Hirschhorn D. Having the cake and eating it? Clofazimine boosts immunotherapy while limiting side effects. Cancer Cell 2024; 42:738-741. [PMID: 38579723 DOI: 10.1016/j.ccell.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/07/2024]
Abstract
Combined immune checkpoint blockade (ICB) for cancer exhibits good efficacy in a subset of patients but also associates with immune-related adverse events. Xue et al. use an elegant drug screening strategy to identify the antimicrobial drug clofazimine as an agent that both potentiates ICB efficacy and decreases immune-related adverse events.
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Affiliation(s)
- Lukas Kraehenbuehl
- Pharmacology Program, Weill Cornell Graduate School, New York, NY, USA; Swim Across America and Ludwig Collaborative Laboratory, Department of Pharmacology, Weill Cornell Medical Center, New York, NY, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medical Center, New York, NY, USA; Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jedd D Wolchok
- Swim Across America and Ludwig Collaborative Laboratory, Department of Pharmacology, Weill Cornell Medical Center, New York, NY, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medical Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical Center, New York, NY, USA; Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School, New York, NY, USA; Parker Institute for Cancer Immunotherapy, Weill Cornell Medicine, New York, NY, USA
| | - Taha Merghoub
- Pharmacology Program, Weill Cornell Graduate School, New York, NY, USA; Swim Across America and Ludwig Collaborative Laboratory, Department of Pharmacology, Weill Cornell Medical Center, New York, NY, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medical Center, New York, NY, USA; Parker Institute for Cancer Immunotherapy, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Hirschhorn
- Pharmacology Program, Weill Cornell Graduate School, New York, NY, USA; Swim Across America and Ludwig Collaborative Laboratory, Department of Pharmacology, Weill Cornell Medical Center, New York, NY, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medical Center, New York, NY, USA.
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14
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Wan Z, Huang J, Ou X, Lou S, Wan J, Shen Z. Psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. An Bras Dermatol 2024; 99:425-432. [PMID: 38388337 PMCID: PMC11074622 DOI: 10.1016/j.abd.2023.09.003] [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: 08/18/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 02/24/2024] Open
Abstract
PD-1 (programmed Death-1) immune checkpoint inhibitors have provided significant benefits to tumor patients. However, a considerable proportion of the patients develop immune-related adverse events (irAEs), of which cutaneous irAEs (cirAEs, e.g., psoriasis) occur relatively early. This review provides an overview of the current progress in psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. It not only describes the relevant influencing factors but also theoretically analyzes the immunological mechanisms that lead to the onset or exacerbation of psoriasis. Finally, the authors present guidelines for the treatment of psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. The review is intended to assist dermatologists in the early recognition and effective individualized management of such cirAE, which is helpful to continue or adjust the tumor-targeted immunotherapy on the basis of ensuring the quality of life of tumor patients.
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Affiliation(s)
- Zi Wan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiangyuan Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaojie Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shuang Lou
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jianji Wan
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhu Shen
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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15
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Storgard R, Markova A. Cutaneous Hypersensitivity Reactions to Immune Checkpoint Inhibitors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1132-1136. [PMID: 38548170 DOI: 10.1016/j.jaip.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
The introduction of immune checkpoint inhibitors (ICIs) has transformed the management of various malignancies. Alongside their therapeutic success, the widespread application of ICIs has unveiled a spectrum of immune-related adverse events (irAEs), most often affecting the skin. Cutaneous irAEs (cirAEs) encompass a range from common morbilliform and lichenoid rashes to more severe conditions such as bullous dermatoses and psoriasiform eruptions, each presenting distinct clinical challenges. Moreover, less common but clinically severe cutaneous reactions like toxic epidermal necrolysis have also been observed. cirAEs are frequently observed, with an incidence ranging from 37% to 70% for anti-cytotoxic T lymphocyte-associated antigen-4 antibodies and 17% to 40% for anti- programmed death-1/anti-programmed death ligand-1 antibodies. Recognizing the critical need for effective therapeutic strategies, this review carefully examines current approaches and guidelines for managing cirAEs.
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Affiliation(s)
- Ryan Storgard
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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16
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Freites-Martinez A, Apalla Z, Fattore D, Fida M, Bang AS, Smith J, Babakoohi S, Lacouture M, Sibaud V. Supportive oncodermatology practices in Europe and the USA. J Eur Acad Dermatol Venereol 2024; 38:e440-e443. [PMID: 38058268 DOI: 10.1111/jdv.19679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Azael Freites-Martinez
- Oncodermatology Clinic, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
| | - Zoe Apalla
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Monika Fida
- Dermatology Department, University of Medicine of Tirana, Tirana, Albania
| | - Alexander S Bang
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Shahab Babakoohi
- Atrium Health Levine Cancer, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mario Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vincent Sibaud
- Oncodermatology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
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17
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Liu JJ, Xu XY, Han H, Wang T, Zhang W, Cui J, Semenov M. Case report: Envafolimab causes local skin necrosis. Front Immunol 2024; 15:1336311. [PMID: 38585260 PMCID: PMC10995323 DOI: 10.3389/fimmu.2024.1336311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Envafolimab is a Chinese domestic innovative fusion of a humanized single-domain programmed death-ligand 1 (PD-L1) antibody (dAb) and human immunoglobulin IgG1 crystalline fragment (Fc) developed for subcutaneous injections. It was granted conditional market authorization by the China National Medical Product Administration (NMPA) in December 2021. Envafolimab is used to treat adult patients with previously treated microsatellite instability-high (MSI-H) or deficient mismatch repair (dMMR) advanced solid tumors, including patients with advanced colorectal cancer disease progression who were previously administered fluorouracil, oxaliplatin, and irinotecan, as well as other patients with advanced solid tumors who experienced disease progression after receiving standard treatment and had no other alternative treatment options. However, the lack of post-marketing clinical trial data requires conducting more clinical studies on the safety and efficacy of envafolimab in order to provide scientific basis and a reference for future therapeutic applications. In this paper, we report a case of severe skin necrosis and bleeding in the area of injection after subcutaneous administration of envafolimab in a patient diagnosed with hepatocellular carcinoma. We discuss issues that must be considered before administration of a PD-L1 inhibitor subcutaneously, which could induce immune mechanisms leading to skin necrosis in the area of injection.
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Affiliation(s)
- Jing Jing Liu
- Yu Lin City First Hospital (Yan An University Second Affiliated Hospital) Pharmaceutical Department, Yu Lin, Shaanxi, China
| | - Xiao Ya Xu
- Yu Lin City First Hospital (Yan An University Second Affiliated Hospital) Pharmaceutical Department, Yu Lin, Shaanxi, China
| | - Huan Han
- Shaanxi Province People’s Hospital, Pharmaceutical Department, Xi’An, Shaanxi, China
| | - Tong Wang
- Yu Lin City First Hospital (Yan An University Second Affiliated Hospital) Pharmaceutical Department, Yu Lin, Shaanxi, China
| | - Wei Zhang
- Yu Lin City First Hospital (Yan An University Second Affiliated Hospital) Pharmaceutical Department, Yu Lin, Shaanxi, China
| | - Jing Cui
- Yu Lin City First Hospital (Yan An University Second Affiliated Hospital) Department of Oncology, Yu Lin, Shaanxi, China
| | - Maksim Semenov
- Medical Affairs Department, Proswell Medical International Contract Research Organization (CRO), Beijing, China
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18
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Alamon-Reig F, Bosch-Amate X, Giavedoni P, Nikolaou V, Mangas C, Apalla Z, Mayor A, Oikonomou C, Starace M, Sibaud V, Carrera C. Use of omalizumab is associated with improvement of pruritic skin disorders induced by immune checkpoint inhibitors: A retrospective cohort from the European Task Force of Dermatology for Cancer patients. J Am Acad Dermatol 2024; 90:429-432. [PMID: 37844688 DOI: 10.1016/j.jaad.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, FRCB, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Bosch-Amate
- Department of Dermatology, Hospital Clínic de Barcelona, FRCB, Universitat de Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- Department of Dermatology, Hospital Clínic de Barcelona, FRCB, Universitat de Barcelona, Barcelona, Spain
| | - Vasiliki Nikolaou
- DermatoOncology Department, Andreas Sygros Hospital, University of Athens, Athens, Greece
| | - Cristina Mangas
- Dermatology and Oncology Department, Istituto Oncologico Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Zoe Apalla
- Second Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ander Mayor
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | - Chrysa Oikonomou
- Dermatology Department, General University Hospital of Patra, Patra, Greece
| | - Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Vincent Sibaud
- Departments of Oncodermatology and Clinical Research, Oncopole Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - Cristina Carrera
- Department of Dermatology, Hospital Clínic de Barcelona, FRCB, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain.
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19
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Ingen-Housz-Oro S, Elshot YS, Segura S, Marchand A, Pouessel D, Kluger N, de Barros Silva G, Ortiz-Brugues A, Aubert M, Saldana C, Mavroudis D, Burle E, Tournier E, Koumaki D, Sibaud V. Skin toxicity of enfortumab vedotin: Proposal of a specific management algorithm. J Eur Acad Dermatol Venereol 2024; 38:e99-e101. [PMID: 37607297 DOI: 10.1111/jdv.19454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Univ Paris Est Créteil EpiDermE, Créteil, France
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
| | - Yannick S Elshot
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sonia Segura
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antoine Marchand
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Dermatology Unit, Department of Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Damien Pouessel
- Oncology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - Nicolas Kluger
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Dermatology Department, Helsinki University Hospital, Helsinki, Finland
| | - Giselle de Barros Silva
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Dermatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Ariadna Ortiz-Brugues
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Oncology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - Marine Aubert
- Oncology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Carolina Saldana
- Oncology Department, AP-HP, Henri Mondor Hospital, Créteil, France
- Univ Paris Est Creteil, TRePCa, Créteil, France
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Estelle Burle
- Oncology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - Emilie Tournier
- Department of Pathology, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - Dimitra Koumaki
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Department of Dermatology and Venereology, University Hospital of Heraklion, Crete, Greece
| | - Vincent Sibaud
- Dermatology for Cancer Patients EADV Task Force, Toulouse, France
- Oncology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
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20
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Kluger N, Marcaillou M, Sibaud V. Nivolumab-induced poliosis restricted to a tattoo: A coincidental association? Ann Dermatol Venereol 2023; 150:225-226. [PMID: 37271607 DOI: 10.1016/j.annder.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/06/2022] [Accepted: 01/19/2023] [Indexed: 06/06/2023]
Affiliation(s)
- N Kluger
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; "Tattoo Unit", Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Marcaillou
- Department of Oncodermatology, Institut Claudius REGAUD and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - V Sibaud
- Department of Oncodermatology, Institut Claudius REGAUD and Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.
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21
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Kraehenbuehl L, Schneider S, Pawlik L, Mangana J, Cheng P, Dummer R, Meier-Schiesser B. Cutaneous Adverse Events of Systemic Melanoma Treatments: A Retrospective Single-Center Analysis. Pharmaceuticals (Basel) 2023; 16:935. [PMID: 37513847 PMCID: PMC10383648 DOI: 10.3390/ph16070935] [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: 05/10/2023] [Revised: 05/28/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Recent progress in the treatment of advanced melanoma has led to the improved survival of affected patients. However, novel treatments also lead to considerable and distinct skin toxicity. To further characterize cutaneous adverse events (AE) of systemic treatments, we conducted a single-center retrospective study of biopsy-proven cutaneous adverse events of melanoma treatment over a period of 10 years at the University Hospital of Zurich, Switzerland. In 102 identified patients, 135 individual skin AEs developed. Immune checkpoint blockade (ICB) was causal for 81 skin AEs, and 54 were related to targeted therapies (TT). Recorded types of skin AEs included lichenoid, maculopapular, acneiform, urticarial, panniculitis, folliculitis, psoriasiform, granulomatous, eczematous, and others. The incidence of skin AEs was higher with TT (18.54%) than with ICB (9.64%, p = 0.0029). Most AEs were low-grade, although 19.21% of AEs were common terminology criteria for adverse events (CTCAE) Grades 3 or 4. A large spectrum of skin AEs was documented during treatment of advanced melanoma, and distinct phenotypes were observed, depending on treatment classes. AEs occurred earlier during treatment with TT than with ICB, and distinct types of skin AEs were associated with respective treatment classes. This study comprehensively describes skin AEs occurring during systemic treatment for melanoma at a single center.
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Affiliation(s)
- Lukas Kraehenbuehl
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Stephanie Schneider
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Laura Pawlik
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Phil Cheng
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
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22
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Kuo AMS, Gu S, Stoll J, Moy AP, Dusza SW, Gordon A, Haliasos EC, Janjigian Y, Kraehenbuehl L, Quigley EA, Chapman P, Lacouture ME, Markova A. Management of immune-related cutaneous adverse events with dupilumab. J Immunother Cancer 2023; 11:e007324. [PMID: 37270183 PMCID: PMC10255229 DOI: 10.1136/jitc-2023-007324] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICI) target the PD-1/PD-L1 and CTLA-4 pathways and allows the immune system to deliver antitumor effects. However, it is also associated with well-documented immune-related cutaneous adverse events (ircAEs), affecting up to 70-90% of patients on ICI. In this study, we describe the characteristics of and patient outcomes with ICI-associated steroid-refractory or steroid-dependent ircAEs treated with dupilumab. Patients with ircAEs treated with dupilumab between March 28, 2017, and October 1, 2021, at Memorial Sloan Kettering Cancer Center were included in this retrospective study, which assessed the rate of clinical response of the ircAE to dupilumab and any associated adverse events (AEs). Laboratory values were compared before and after dupilumab. All available biopsies of the ircAEs were reviewed by a dermatopathologist. Thirty-four of 39 patients (87%, 95% CI: 73% to 96%) responded to dupilumab. Among these 34 responders, 15 (44.1%) were complete responders with total ircAE resolution and 19 (55.9%) were partial responders with significant clinical improvement or reduction in severity. Only 1 patient (2.6%) discontinued therapy due to AEs, specifically, injection site reaction. Average eosinophil counts decreased by 0.2 K/mcL (p=0.0086). Relative eosinophils decreased by a mean of 2.6% (p=0.0152). Total serum immunoglobulin E levels decreased by an average of 372.1 kU/L (p=0.0728). The most common primary inflammatory patterns identified on histopathological examination were spongiotic dermatitis (n=13, 33.3%) and interface dermatitis (n=5, 12.8%). Dupilumab is a promising option for steroid-refractory or steroid-dependent immune-related cutaneous adverse events, particularly those that are eczematous, maculopapular, or pruritic. Among this cohort, dupilumab was well-tolerated with a high overall response rate. Nonetheless, prospective, randomized, controlled trials are warranted to confirm these observations and confirm its long-term safety.
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Affiliation(s)
- Alyce Mei-Shiuan Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephanie Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Stoll
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
| | - Andrea P Moy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allison Gordon
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
| | - Elena C Haliasos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yelena Janjigian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lukas Kraehenbuehl
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth A Quigley
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Paul Chapman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
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23
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Ingen-Housz-Oro S, Milpied B, Bensaid B, Elshot Y, Brüggen MC, Starace M, Kaffenberger BH, Carrera C, Pham-Ledard A, Freites-Martinez A, Sanchez-Pena P, Lebrun-Vignes B, French LE, Sibaud V. Drug reactions with eosinophilia and systemic symptoms induced by immune checkpoint inhibitors: an international cohort of 13 cases. Melanoma Res 2023; 33:155-158. [PMID: 36749114 DOI: 10.1097/cmr.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), drug reactions with eosinophilia and systemic symptoms (DRESS) have been very rarely reported. The objective of this study is to better define the clinical and histologic features, treatment and prognosis of ICI-related DRESS. This retrospective case series was conducted between 01 January 2015 and 31 December 2021 by the dermatology departments of five international networks involved in drug reactions. Inclusion criteria were age ≥18 years old, DRESS with Regiscar score ≥4 (probable or certain) and ICI as a suspect drug. Clinical, biologic and follow-up data were extracted from the medical charts. Thirteen patients were included. The median time to onset was 22 days (3-11). No patients had a high-risk drug introduced in the past 3 months. A majority of patients presented fever (92%), diffuse exanthema (77%) and facial edema (69%). Biologic features included hypereosinophilia in eight patients (61.5%), hyperlymphocytosis in 3 (23%), elevated liver function tests in 11 (85%, grade 1 or 2 in most cases) and renal involvement in 5 (38%). Two patients (15%) had lung involvement. PCR evidence of viral replication was detected in five patients (38.5%). Treatment involved discontinuation of the suspect ICI and systemic steroids with variable dose and duration regimens. Among the four patients in which ipilimumab + nivolumab combination therapy was initially suspected, one was rechallenged with nivolumab monotherapy with good tolerance. Five patients were switched to another anti-PD-1 plus low-dose systemic steroids, with good tolerance in four cases. No patient died because of DRESS. DRESS induced by ICI are rare and of moderate severity. A consensus for management is still pending.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- University Paris est Créteil EpidermE, Créteil, France
- EADV European Task Force 'Dermatology for cancer patients'
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
| | - Brigitte Milpied
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- EADV European Task Force 'Dermatology for cancer patients'
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Dermatology Department, CHU Bordeaux, Bordeaux
| | - Benoit Bensaid
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Dermatology Department, CHU Edouard Herriot, Lyon, France
| | - Yannick Elshot
- EADV European Task Force 'Dermatology for cancer patients'
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie Charlotte Brüggen
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Department of Dermatology, University Hospital Zurich
- Faculty of Medicine, University Zurich, Zurich
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Michela Starace
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology -IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy
| | - Benjamin H Kaffenberger
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology Department, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cristina Carrera
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona
- CIBERER Centro de investigaciones Biomedicas en Red de Enfermedades Raras Insituto de Salud Carlos III
- Pharmacovigilance Technical Committee Hospital Clinic Barcelona
| | | | - Azael Freites-Martinez
- EADV European Task Force 'Dermatology for cancer patients'
- Oncodermatology Clinic, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
| | - Paola Sanchez-Pena
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- Pharmacovigilance Department, CHU Bordeaux, Bordeaux
| | - Bénédicte Lebrun-Vignes
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- Pharmacovigilance Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Lars E French
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilan University (LMU) Munich, Munich, Germany
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vincent Sibaud
- EADV European Task Force 'Dermatology for cancer patients'
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
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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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25
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Hussain K, Kanji A, Zaheri S, Malek D, Terlizzo M, Weir J, Turajlic S, Fearfield L. Checkpoint inhibitor therapy and psoriasis: a case series. Clin Exp Dermatol 2023; 48:254-256. [PMID: 36763756 DOI: 10.1093/ced/llac095] [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: 10/10/2022] [Accepted: 11/23/2022] [Indexed: 01/22/2023]
Abstract
Checkpoint inhibitor therapy (CPI) has significantly improved overall survival in several cancers, including metastatic melanoma and in the adjuvant setting. Cutaneous immune-related adverse events secondary to CPI are commonly observed; however, the development of psoriasis or exacerbation of existing psoriasis has not been widely reported and management can be challenging.
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Affiliation(s)
- Khawar Hussain
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Alpa Kanji
- Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Dalila Malek
- Department of Dermatology, Southend University Hospital, Basildon, UK
| | - Monica Terlizzo
- Department of Histopathology, Royal Marsden Hospital, London, UK
| | - Justin Weir
- Department of Histopathology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Samra Turajlic
- Skin and Melanoma Unit, Royal Marsden Hospital, London, UK
| | - Louise Fearfield
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Skin and Melanoma Unit, Royal Marsden Hospital, London, UK
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26
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Freites-Martinez A, Nikolaou V, Lallas K, Carrera C, Sollena P, Apalla Z, Starace M, Fattore D, Fabbrocini G, Segura S, Riganti J, Sibaud V. Clinical characterization and treatment outcomes of follicular cutaneous immune-related adverse events caused by immune checkpoint inhibitors: A multicenter retrospective study. J Am Acad Dermatol 2023; 88:718-720. [PMID: 36152697 DOI: 10.1016/j.jaad.2022.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Azael Freites-Martinez
- Oncodermatology Clinic, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain.
| | - Vasiliki Nikolaou
- First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodestrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Lallas
- First Department of Dermatology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Cristina Carrera
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Melanoma Group, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Pietro Sollena
- Dermatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Zoe Apalla
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michela Starace
- Department of Specialized, Dermatology-IRCCS, Policlinico Sant'Orsola, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Sonia Segura
- Department of Dermatology, Hospital del Mar - Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Julia Riganti
- Dermatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vincent Sibaud
- Oncodermatology Department, Institut Universitaire du cancer, Toulouse Oncopole, Toulouse, France
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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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28
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Luangnara A, Kiratikanon S, Ketpueak T, Suksombooncharoen T, Charoentum C, Chewaskulyong B, Tovanabutra N, Chiewchanvit S, Nochaiwong S, Chuamanochan M. Incidence and factors associated with cutaneous immune-related adverse events to immune check point inhibitors: An ambispective cohort study. Front Immunol 2022; 13:965550. [PMID: 36341419 PMCID: PMC9630333 DOI: 10.3389/fimmu.2022.965550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although immune checkpoint inhibitors (ICIs) have become the frontline treatment option for patients with various advanced cancers due to improved survival, they can be associated with a spectrum of cutaneous immune-related adverse events (cirAEs). However, little is known regarding the occurrence and patterns of cirAE-related ICI therapy in patients of different races other than white populations. Therefore, we investigated the incidence and associated factors of cirAEs among cancer patients in northern Thailand. Methods A referral-center-based ambispective cohort study was conducted from January 1, 2017, to March 31, 2021. Based on a linked database and merged patient-level data, adult patients with pathologically confirmed cancer who were diagnosed and received ICI therapy regardless of cancer type and followed up through August 31, 2021, were included. All cirAE-related ICI therapy was based on clinical evaluation and ascertainment by a board-certified dermatologist. The incidence of cirAE-related ICI therapy with confidence intervals (CIs) across cancer- and ICI therapy-specific groups was estimated. Factors associated with cirAEs were evaluated using multivariable modified Poisson regression to estimate risk ratios (RRs) and 95% CIs. Results The study included 112 patients (67 men [59.8%]; mean age, 65.0 [range, 31.0-88.0] years), who were mainly diagnosed with lung cancer (56.3%), followed by liver cancer (19.6%). The overall incidence of cirAE-related ICI therapy was 32.1% (95% CI, 24.1-41.4); however, there was no substantial difference in sex, cancer type, or individual ICI therapy. The two identified prognostic risk factors of cirAE-related ICI therapy were age >75 years (adjusted RR, 2.13; 95% CI, 1.09-4.15; P=0.027) and pre-existing chronic kidney disease stages 3-4 (adjusted RR, 3.52; 95% CI, 2.33-5.31; P<0.001). Conclusions The incidence of cirAE-related ICI therapy among Thai cancer patients was comparable to that in white populations. Early identification, particularly in elderly patients and those with CKD, should be implemented in clinical practice to help optimize therapeutic decision-making and patient health outcomes.
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Affiliation(s)
| | - Salin Kiratikanon
- Division of Dermatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanika Ketpueak
- Division of Oncology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Chaiyut Charoentum
- Division of Oncology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Busyamas Chewaskulyong
- Division of Oncology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napatra Tovanabutra
- Division of Dermatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siri Chiewchanvit
- Division of Dermatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Surapon Nochaiwong
- Division of Dermatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Mati Chuamanochan, ; Surapon Nochaiwong,
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Mati Chuamanochan, ; Surapon Nochaiwong,
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Yu Y, Zhou Y, Zhang X, Tan K, Zheng J, Li J, Cui H. Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies. Front Oncol 2022; 12:934093. [PMID: 35912183 PMCID: PMC9334704 DOI: 10.3389/fonc.2022.934093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Immunotherapies represented by immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. A large part of the population has both cancer and psoriasis but is usually excluded from ICI clinical trials because of the dysregulated activation of the immune system. This is the first study to evaluate the safety and efficacy of ICI therapy in patients with cancer and preexisting psoriasis. Methods PubMed, EMBASE, Cochrane, and MEDLINE databases were searched from inception through February 2022. Observational studies on patients with cancer and confirmed psoriasis before ICI initiation were included. Outcomes included the incidence of psoriasis flares, de novo immune-related adverse events (irAEs), discontinuation rate due to flare/de novo irAEs, and efficacy of ICI therapy. Clinical manifestations, management, and outcomes for adverse events (AEs) were systematically reviewed. All pooled analyses were based on a random-effects model using Stata software. Meta-regression and subgroup analyses were performed to identify sources of heterogeneity. Results Twelve studies involving 191 patients were included. The pooled incidence of psoriasis flares was 45.0% (95% CI: 31.1%-58.9%, I2 = 71.7%) and 44.9% (95% CI: 29.0%–60.7%, I2 = 71.8%) for de novo irAEs. The tumor type, psoriasis subtype, ICI class, and country were the main sources of heterogeneity. Grade 3–4 flares occurred in 10.8% (95% CI: 5.3%–16.3%) of patients, and about 16.6% (95% CI: 10.7%–22.5%) of patients experienced grade 3–4 de novo irAEs. The estimated incidence of ICI discontinuation due to AE was 18.5% (95% CI: 6.1%–30.8%, I2 = 68.7%). The median times to develop flare and de novo irAEs were 44 and 63 days, respectively. Endocrinopathies and colitis were the most common de novo irAEs. Conventional therapy is effective for most AEs. The estimated objective response rate (ORR) of ICIs was 38.1% (95% CI: 11.8%–64.3%, I2 = 81.7%), and the disease control rate (DCR) was 64.5% (95% CI: 55.3%–73.8%, I2 = 0). Conclusions The flare of patients with cancer and preexisting psoriasis treated with ICI therapy is frequent, but the incidence of de novo irAEs and the efficacy of ICI therapy are comparable to those of the general population. Most AEs are mild and manageable with conventional therapy, which required discontinuation of ICI therapy in 18.5%. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022320646
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Affiliation(s)
- Yixuan Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yang Zhou
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Kexin Tan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jiabin Zheng
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jia Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Huijuan Cui
- Oncology Department of Integrative Medicine, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Huijuan Cui,
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30
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Kuo AM, Kraehenbuehl L, King S, Leung DYM, Goleva E, Moy AP, Lacouture ME, Shah NJ, Faleck DM. Contribution of the Skin-Gut Axis to Immune-Related Adverse Events with Multi-System Involvement. Cancers (Basel) 2022; 14:cancers14122995. [PMID: 35740660 PMCID: PMC9221505 DOI: 10.3390/cancers14122995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Increasing numbers of cancer patients are treated with immunotherapy that activates their immune systems to control or even eliminate tumors. However, a substantial proportion of patients experience adverse events mediated by the unleashed immune system. The skin is one of the most frequently affected organs, with toxicities typically manifesting as distinct types of rashes. The gastrointestinal (GI) tract is also commonly affected, with a wide spectrum of symptom manifestations that can range from self-limited diarrhea to life-threatening colitis. Here we present the relationship between skin and GI adverse events among cancer patients receiving treatment with immune checkpoint blockade, which has not been well-studied. Abstract Immune-related adverse events (irAEs) frequently complicate treatment with immune checkpoint blockade (ICB) targeting CTLA-4, PD-1, and PD-L1, which are commonly used to treat solid and hematologic malignancies. The skin and gastrointestinal (GI) tract are most frequently affected by irAEs. While extensive efforts to further characterize organ-specific adverse events have contributed to the understanding and management of individual toxicities, investigations into the relationship between multi-organ toxicities have been limited. Therefore, we aimed to conduct a characterization of irAEs occurring in both the skin and gut. A retrospective analysis of two cohorts of patients treated with ICB at Memorial Sloan Kettering Cancer Center was conducted, including a cohort of patients with cutaneous irAEs (ircAEs) confirmed by dermatologists (n = 152) and a cohort of patients with biopsy-proven immune-related colitis (n = 246). Among both cohorts, 15% (61/398) of patients developed both skin and GI irAEs, of which 72% (44/61) patients had ircAEs preceding GI irAEs (p = 0.00013). Our study suggests that in the subset of patients who develop both ircAEs and GI irAEs, ircAEs are likely to occur first. Further prospective studies with larger sample sizes are needed to validate our findings, to assess the overall incidence of co-incident irAEs, and to determine whether ircAEs are predictors of other irAEs. This analysis highlights the development of multi-system dermatologic and gastrointestinal irAEs and underscores the importance of oncologists, gastroenterologists, and dermatologists confronted with an ircAE to remain alert for additional irAEs.
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Affiliation(s)
- Alyce M. Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
| | - Lukas Kraehenbuehl
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence: or
| | - Stephanie King
- Gastroenterology, Hepatology & Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.K.); (D.M.F.)
| | - Donald Y. M. Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health Hospital, Denver, CO 80206, USA; (D.Y.M.L.); (E.G.)
| | - Elena Goleva
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health Hospital, Denver, CO 80206, USA; (D.Y.M.L.); (E.G.)
| | - Andrea P. Moy
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Mario E. Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
| | - Neil J. Shah
- Genitourinary Solid Tumor Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - David M. Faleck
- Gastroenterology, Hepatology & Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.K.); (D.M.F.)
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31
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Ingen-Housz-Oro S, Milpied B, Badrignans M, Carrera C, Elshot YS, Bensaid B, Segura S, Apalla Z, Markova A, Staumont-Sallé D, Marti-Marti I, Giavedoni P, Chua SL, Darrigade AS, Dezoteux F, Starace M, Torre AC, Riganti J, de Prost N, Lebrun-Vignes B, Bauvin O, Walsh S, Ortonne N, French LE, Sibaud V. Severe blistering eruptions induced by immune checkpoint inhibitors: a multicentre international study of 32 cases. Melanoma Res 2022; 32:205-210. [PMID: 35377864 PMCID: PMC9377568 DOI: 10.1097/cmr.0000000000000819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), bullous life-threatening reactions are rare. To better define the clinical and histological features, treatment, and prognosis of ICI-related severe blistering cutaneous eruptions. This retrospective case series was conducted between 2014/05/15 and 2021/04/15 by the dermatology departments of four international registries involved in drug reactions. Inclusion criteria were age ≥18 years old, skin eruption with blisters with detachment covering ≥1% body surface area and at least one mucous membrane involved, available pictures, and ICI as suspect drug. Autoimmune bullous disorders were excluded. Each participant medical team gave his own diagnosis conclusion: epidermal necrolysis (EN), severe lichenoid dermatosis (LD), or unclassified dermatosis (UD). After a standardized review of pictures, cases were reclassified by four experts in EN or LD/UD. Skin biopsies were blindly reviewed. Thirty-two patients were included. Median time to onset was 52 days (3-420 days). Cases were originally diagnosed as EN in 21 cases and LD/UD in 11 cases. After review by experts, 10/21 EN were reclassified as LD/UD. The following manifestations were more frequent or severe in EN: fever, purpuric macules, blisters, ocular involvement, and maximal detachment. Most patients were treated with topical with or without systemic corticosteroids. Eight patients (25%) died in the acute phase. The culprit ICI was not resumed in 92% of cases. In three patients, another ICI was given with a good tolerance. Histology did not reveal significant differences between groups. Severe blistering cutaneous drug reactions induced by ICI are often overdiagnosed as EN. Consensus for management is pending.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology department, AP-HP, Henri Mondor hospital, Créteil, France
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- Univ Paris est Créteil EpidermE, Créteil, France
- European Task Force “Dermatology for cancer patients” of EADV
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
| | - Brigitte Milpied
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- European Task Force “Dermatology for cancer patients” of EADV
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Dermatology department, CHU Bordeaux, Bordeaux, France
| | - Marine Badrignans
- Pathology department, AP-HP, Henri Mondor hospital, Créteil, France
- Université Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - Cristina Carrera
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
- CIBERER Centro de investigaciones Biomedicas en Red de Enfermedades Raras Insituto de Salud Carlos III, Spain
- Pharmacovigilance Technical Committee Hospital Clinic Barcelona, Spain
| | - Yannick S. Elshot
- European Task Force “Dermatology for cancer patients” of EADV
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, The Netherlands
| | - Benoit Bensaid
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- Dermatology department, CHU Edouard Herriot, Lyon, France
| | - Sonia Segura
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - Zoé Apalla
- European Task Force “Dermatology for cancer patients” of EADV
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Greece
| | - Alina Markova
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Delphine Staumont-Sallé
- FISARD group, Paris, France
- Dermatology Department, CHU Lille, University Lille, INFINITE U1286 Inserm, Lille, France
| | - Ignasi Marti-Marti
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Ser-Ling Chua
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Department of Dermatology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anne-Sophie Darrigade
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- Dermatology department, CHU Bordeaux, Bordeaux, France
| | - Frédéric Dezoteux
- FISARD group, Paris, France
- Dermatology Department, CHU Lille, University Lille, INFINITE U1286 Inserm, Lille, France
| | - Michela Starace
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology -IRCCS Policlinico di Sant’Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy
| | - Ana Clara Torre
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Julia Riganti
- European Task Force “Dermatology for cancer patients” of EADV
- Dermatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolas de Prost
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- Intensive care unit, AP-HP, Henri Mondor hospital, Créteil, France
| | - Bénédicte Lebrun-Vignes
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- FISARD group, Paris, France
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Regional Pharmacovigilance Center, AP-HP, Pitié-Salpêtrière hospital, Paris, France
| | - Olivia Bauvin
- FISARD group, Paris, France
- Dermatology department, CHU Charles Nicolle, Rouen, France
| | - Sarah Walsh
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Department of Dermatology, King’s College Hospital, London, United Kingdom
| | - Nicolas Ortonne
- Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, Créteil, France
- Pathology department, AP-HP, Henri Mondor hospital, Créteil, France
- Université Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - Lars E. French
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris, France
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilan University (LMU) Munich, Munich, Germany
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Vincent Sibaud
- European Task Force “Dermatology for cancer patients” of EADV
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
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Sample CME Manuscript Submission – Response to Pham et al. “Review BRAF inhibition and the spectrum of granulomatous reactions". J Am Acad Dermatol 2022; 87:e85-e88. [DOI: 10.1016/j.jaad.2022.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022]
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Fabregat-Pratdepadua M, Boada A, Manzano JL, Bielsa I, Verdaguer-Faja J, Quer Pi-Sunyer A, Carrascosa JM. Development of morphea during Nivolumab treatment. Australas J Dermatol 2022; 63:269-271. [PMID: 35325471 DOI: 10.1111/ajd.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Fabregat-Pratdepadua
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut Investigació Germans Trias i Pujol (IGTP), Spain
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut Investigació Germans Trias i Pujol (IGTP), Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - José Luis Manzano
- Department of Medical Oncology, ICO-Badalon, Badalona, Barcelona, Spain
| | - Isabel Bielsa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut Investigació Germans Trias i Pujol (IGTP), Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Júlia Verdaguer-Faja
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut Investigació Germans Trias i Pujol (IGTP), Spain
| | - Ariadna Quer Pi-Sunyer
- Department of Nuclear Medicine-PET, Hospital Universitari de Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain.,Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - José-Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut Investigació Germans Trias i Pujol (IGTP), Spain.,Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
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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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35
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Allouchery M, Beuvon C, Pérault-Pochat MC, Roblot P, Puyade M, Martin M. Safety of Immune Checkpoint Inhibitor Resumption after Interruption for Immune-Related Adverse Events, a Narrative Review. Cancers (Basel) 2022; 14:cancers14040955. [PMID: 35205703 PMCID: PMC8870725 DOI: 10.3390/cancers14040955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have become the standard of care for several types of cancer due to their superiority in terms of survival benefits in first- and second-line treatments compared to conventional therapies, and they present a better safety profile (lower absolute number of grade 1-5 adverse events), especially if used in monotherapy. However, the pattern of ICI-related adverse events is totally different, as they are characterized by the development of specific immune-related adverse events (irAEs) that are unique in terms of the organs involved, onset patterns, and severity. The decision to resume ICI treatment after its interruption due to irAEs is challenged by the need for tumor control versus the risk of occurrence of the same or different irAEs. Studies that specifically assess this point remain scarce, heterogenous and mostly based on small samples of patients or focused only on the recurrence rate of the same irAE after ICI resumption. Moreover, patients with grade ≥3 irAEs were excluded from many of these studies. Herein, we provide a narrative review on the field of safety of ICI resumption after interruption due to irAE(s).
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Affiliation(s)
- Marion Allouchery
- Pharmacologie Clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France; (M.A.); (M.-C.P.-P.)
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
| | - Clément Beuvon
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
| | - Marie-Christine Pérault-Pochat
- Pharmacologie Clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France; (M.A.); (M.-C.P.-P.)
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
- Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U1084, Université de Poitiers, 1 Rue Georges Bonnet, 86073 Poitiers, France
| | - Pascal Roblot
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
| | - Mathieu Puyade
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Mickaël Martin
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
- INSERM U1313, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
- Correspondence: ; Tel.: +33-549-444-004
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