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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 28 novembre 2019
Doi : 10.1016/j.jaad.2019.06.035
accepted : 17 June 2019
Survival and prognosis of individuals receiving programmed cell death 1 inhibitor with and without immunologic cutaneous adverse events
 

Linda Chan, MBBS, MMed a, , Shelley J.E. Hwang, MBBS (Hons), MMed a, b, Karen Byth, PhD c, d, Merribel Kyaw, MBBS (Hons), BSc (Med) Hon e, Matteo S. Carlino, MBBS, PhD, FRACP f, g, Shaun Chou, MBBS, FRCPA h, Pablo Fernandez-Penas, MBBS, PhD, FACD a, b
a Department of Dermatology, Westmead Hospital, Sydney, Australia 
b Sydney Medical School, The University of Sydney, Westmead, Australia 
c Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Westmead, Australia 
d NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, Australia 
e Department of Radiology, Westmead Hospital, Sydney, Australia 
f Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, Australia 
g Melanoma Institute Australia, The University of Sydney, Sydney, Australia 
h Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Sydney, Australia 

Correspondence to: Linda Chan, MBBS, MMed, D5A, Department of Dermatology, Westmead Hospital, Cnr of Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.D5A, Department of Dermatology, Westmead Hospital, Cnr of Darcy and Hawkesbury RoadWestmeadNSW2145Australia
Abstract
Background

The treatment response to new immunotherapy in advanced melanoma patients remains varied between individuals. Immune-related cutaneous side effects might have prognostic value.

Objective

To determine whether development of ≥1 of the 3 immune-mediated cutaneous events (eczema, lichenoid reaction, or vitiligo-like depigmentation) is associated with improved progression-free survival.

Methods

A cohort study of adults with stage IIIC-IV melanoma treated with pembrolizumab or nivolumab during May 1, 2012-February 1, 2018, at Westmead Hospital, Sydney, Australia. Treatment response was based on iRECIST version 1.1.

Results

In total, 82 patients of an average age of 59.9 years were included. Median follow-up was 40.7 months; 33 patients had ≥1 target skin reaction. Skin reactions developed in one-third of individuals by 6 months. At any given time, the instantaneous risk of disease progression and death was lower for individuals who had ≥1 cutaneous adverse event (CAE) develop. Compared with individuals with no CAE, the hazard ratio for disease progression and death for individuals who had ≥1 CAE develop was 0.46 (95% confidence interval 0.23-0.91; P  = .025) by the time-dependent Cox proportional hazards model.

Limitations

Single-center study.

Conclusion

This study demonstrates an association between the development of ≥1 of 3 CAEs and improved progression-free survival in this cohort of patients.

The full text of this article is available in PDF format.

Key words : dermatitis, lichenoid reaction, melanoma, PD-1, vitiligo-like depigmentation

Abbreviations used : CAE, CI, HR, PD-1, PFS



 Ms Chan and Ms Hwang contributed equally in this study.
 Funding sources: None.
 Conflicts of interest: None disclosed.
 Reprints not available from the authors.



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