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Merli M, Accorinti M, Romagnuolo M, Marzano A, Di Zenzo G, Moro F, Antiga E, Maglie R, Cozzani E, Parodi A, Gasparini G, Sollena P, De Simone C, Caproni M, Pisano L, Fattore D, Balestri R, Sena P, Vezzoli P, Teoli M, Ardigò M, Vassallo C, Michelerio A, Satta RR, Dika E, Melotti B, Ribero S, Quaglino P. Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience. Front Med (Lausanne) 2023; 10:1208418. [PMID: 37547602 PMCID: PMC10400335 DOI: 10.3389/fmed.2023.1208418] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue.
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Affiliation(s)
- Martina Merli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Martina Accorinti
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Angelo Marzano
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Francesco Moro
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Sollena
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Clara De Simone
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dermatology Unit, University Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Luigi Pisano
- Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli Federico II, Naples, Italy
| | - Riccardo Balestri
- Division of Dermatology, Outpatient Consultation for Rare Diseases, APSS, Trento, Italy
| | - Paolo Sena
- Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Pamela Vezzoli
- Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Miriam Teoli
- Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Marco Ardigò
- Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Camilla Vassallo
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Michelerio
- Dermatology Unit, Ospedale Cardinal Massaia, Asti, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rosanna Rita Satta
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Emi Dika
- Melanoma Center, Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Dermatology, Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Barbara Melotti
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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Muhaj F, Karri PV, Moody W, Brown A, Patel AB. Mucocutaneous adverse events to immune checkpoint inhibitors. FRONTIERS IN ALLERGY 2023; 4:1147513. [PMID: 36938327 PMCID: PMC10017442 DOI: 10.3389/falgy.2023.1147513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. Since the approval of ipilimumab in 2011, a total of nine ICIs have gained indications for various solid and hematologic malignancies. The expanding use of ICIs in oncology underscores the need for diagnosis and treatment expertise in immune related adverse events (irAE). Cutaneous toxicities are the earliest and most common irAE in this class of therapy. In addition to the more frequent reactions including vitiligo, lichenoid dermatitis, psoriasiform dermatitis, other less common skin toxicities including bullous dermatoses, neutrophilic dermatoses, and autoimmune dermato-rheumatologic diseases have been reported. Even though less than 3% of cutaneous irAEs (irCAEs) are classified as grade 3 or higher events, irCAEs can greatly impact quality of life. Appropriate management of irCAEs is critical to avoid unwarranted interruptions or discontinuation of lifesaving immunotherapy.
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Affiliation(s)
- Fiorinda Muhaj
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Padmavathi V. Karri
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Dermatology, University of Texas Health Science Center- Houston, Houston, TX, United States
| | - Wylie Moody
- Department of Internal Medicine, HCA Houston Healthcare West, Houston, TX, United States
| | - Alexandria Brown
- Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX, United States
| | - Anisha B. Patel
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Correspondence: Anisha B. Patel
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