A case of de novo palmoplantar psoriasis with psoriatic arthritis and autoimmune hypothyroidism after receiving nivolumab therapy

Elosua-González, Marta; Franco, Ana Pampín; Mazzucchelli-Esteban, Ramón; Mielgo-Rubio, Xabier; Rodriguez-Vasquez, Ximena; García‐Zamora, Elena; López‐Estebaranz, José Luis

doi:10.5070/d3238036018

Cited by 23 publications

(16 citation statements)

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“…These included psoriasis and dermatitis ( Fig. 1 G ), both of which have noted similarities to the pathology observed in skin irAEs following ICI therapy ( 24 , 47 – 49 ). Altogether, our results demonstrate that immune checkpoint inhibitors unleash a broad proinflammatory, pathogenic program against a newly acquired member of the skin microbiota, and that our mouse model may represent a unique tool to dissect the etiology and mechanism of action of skin irAEs.…”

Section: Resultsmentioning

confidence: 66%

Immune checkpoint inhibitors unleash pathogenic immune responses against the microbiota

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Lima-Júnior

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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Immune checkpoint inhibitors (ICIs) are essential components of the cancer therapeutic armamentarium. While ICIs have demonstrated remarkable clinical responses, they can be accompanied by immune-related adverse events (irAEs). These inflammatory side effects are of unclear etiology and impact virtually all organ systems, with the most common being sites colonized by the microbiota such as the skin and gastrointestinal tract. Here, we establish a mouse model of commensal bacteria–driven skin irAEs and demonstrate that immune checkpoint inhibition unleashes commensal-specific inflammatory T cell responses. These aberrant responses were dependent on production of IL-17 by commensal-specific T cells and induced pathology that recapitulated the cutaneous inflammation seen in patients treated with ICIs. Importantly, aberrant T cell responses unleashed by ICIs were sufficient to perpetuate inflammatory memory responses to the microbiota months following the cessation of treatment. Altogether, we have established a mouse model of skin irAEs and reveal that ICIs unleash aberrant immune responses against skin commensals, with long-lasting inflammatory consequences.

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Section: Resultsmentioning

confidence: 66%

Immune checkpoint inhibitors unleash pathogenic immune responses against the microbiota

Link

Lima-Júnior

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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“…Pustular psoriasiform irAEs (odds ratio, OR 4.9) and disease involving >10% BSA (OR 3.64) were found to be significant risk factors leading to treatment modification 17 . Our review of de novo cases (Table 1), in which treatment was modified in 10 of 19 patients (53%), also identified extensive disease as the most common reason for discontinuation of nivolumab 26,33,36 . However, severity of psoriasiform irAE (>10% BSA) is a positive predictor of ICI antitumor effect in both univariate (OR 2.55) and multivariate (OR 3.15) analyses 17 .…”

Section: Discussionmentioning

confidence: 84%

“…17 Our review of de novo cases (Table 1), in which treatment was modified in 10 of 19 patients (53%), also identified extensive disease as the most common reason for discontinuation of nivolumab. 26,33,36 However, severity of psoriasiform irAE (>10% BSA) is a positive predictor of ICI antitumor effect in both univariate (OR 2.55) and multivariate (OR 3.15) analyses. 17 Optimal management of psoriasiform irAEs is thus crucial in the overall scheme of ICI-based cancer treatment.…”

Section: Discussionmentioning

confidence: 97%

“…However, in a cohort of 115 patients with psoriasiform irAE, Nikolaou et al 17 reported that 70% of patients had no history of psoriasis. Reports of de novo psoriasis exist, and those associated specifically with nivolumab (20 patients) are summarized in Table 1 20‐37 …”

Section: Discussionmentioning

confidence: 99%

“…Reports of de novo psoriasis exist, and those associated specifically with nivolumab (20 patients) are summarized in Table 1. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The presence or absence of spongiosis and eosinophils in de novo psoriasiform irAE has not been thoroughly reported. None of the cases in our review (Table 1) reported pustular psoriasis with an eosinophilic infiltrate.…”

Section: Discussionmentioning

confidence: 99%

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Severe de novo pustular psoriasiform immune‐related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma

et al. 2021

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Breakthrough targeted therapies have produced significant improvements in survival for cancer patients, but have a propensity to cause cutaneous immune‐related adverse events (irAEs). Psoriasiform irAEs, representing about 4% of dermatologic toxicities associated with immune checkpoint inhibitor (ICI) therapy, are usually mild, occur in older patients and present as an exacerbation of existing psoriasis after several doses of ICI therapy. We report a case of a 58‐year‐old woman with metastatic esophageal adenocarcinoma and no prior history of psoriasis who developed a pustular psoriasiform irAE, beginning 3 days after initiation of nivolumab and progressing to confluent erythroderma with pustules over 2 weeks despite topical steroid use. She had concurrent acrodermatitis enteropathica, clinically diagnosed and confirmed with a low serum zinc level, that improved with supplementation. Her psoriasiform irAE was refractory to systemic steroids and acitretin, prompting discontinuation of nivolumab and treatment with ustekinumab and concomitant slow taper of acitretin and prednisone. Pustular psoriasiform irAE is a rare but severe dermatologic toxicity resulting from ICI therapy. Given the diverse morphologic types of cutaneous irAEs that can occur during ICI therapy, a clinical and histopathologic examination of dermatologic toxicities is critical to identify patients who may benefit from biologic therapy.

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Latest Research in Nail Psoriasis

Pasch

Iorizzo

2021

Advances in Nail Disease and Management

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A case of de novo palmoplantar psoriasis with psoriatic arthritis and autoimmune hypothyroidism after receiving nivolumab therapy

Cited by 23 publications

References 0 publications

Immune checkpoint inhibitors unleash pathogenic immune responses against the microbiota

Immune checkpoint inhibitors unleash pathogenic immune responses against the microbiota

Severe de novo pustular psoriasiform immune‐related adverse event associated with nivolumab treatment for metastatic esophageal adenocarcinoma

Latest Research in Nail Psoriasis

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