There is increasing recognition of distinct inflammatory eruptions associated with checkpoint inhibitors. A better understanding of their severity, therapeutic response, and impact on cancer treatment is needed.
To analyze the different rashes associated with immunotherapy referred to our institution's oncodermatology clinic and inpatient consultative service and to evaluate their therapeutic response and impact on immunotherapy.
We retrospectively reviewed the medical records of patients referred to the oncodermatology clinic or inpatient dermatology service during 2016-2018 at Yale-New Haven Hospital for eruptions that developed during immunotherapy.
In total, 98 patients (51 men, 47 women) treated with checkpoint inhibitors developed 103 inflammatory eruptions, with a range of mean latency of 0.2-17.7 months. A minority of patients (25/103; 24.3%) required immunotherapy interruption; most of these cases involved immunobullous (7/8; 87.5%), lichenoid (8/26; 30.8%), maculopapular (6/18; 33.3%), and Stevens-Johnson syndrome–like (2/2, 100%) reactions. Only 3 of 16 (18.8%) patients who had their immunotherapy interrupted had a grade 2 or 3 flare on rechallenge. Most reactions (93/103; 90.3%) responded to dermatologic therapy or immunotherapy interruption.
This was a retrospective study from a single tertiary care center.
A variety of inflammatory reactions might occur from immunotherapy with differing degrees of severity. While most rashes responded to topical treatment, immunobullous and exfoliative presentations frequently interrupted immunotherapy. Increased awareness and early recognition could reduce the need for unnecessary immunotherapy interruption.Le texte complet de cet article est disponible en PDF.
Key words : cutaneous adverse events, cytotoxic T-lymphocyte associated protein 4, dermatologic toxicities, immune checkpoint inhibitor, immune-related adverse events, immunotherapy, programmed cell death 1, programmed cell death ligand 1
Abbreviations used : AGEP, BSA, CTLA-4, irAE, PD-1, PD-L1, PRP, SJS, UVB
| Funding sources: Supported in part by a National Institutes of Health medical student research fellowship (to Ms Coleman) and immune checkpoint inhibitor toxicity grant (R01 CA227473, to Dr Kluger).
| Conflicts of interest: Dr Kluger served on an advisory board or received consultant fees from Roche-Genentech, Corvus, Nektar, Biodesix, Iovance, Pfizer, and Celldex and received research support from Bristol Meyers Squibb, Merck, Apexigen, and the NIH for immunotherapy toxicities. Dr Leventhal served on an advisory board for Amgen. All other authors have no conflicts of interest to disclose.