A Novel Approach to the Treatment of Pembrolizumab-induced Psoriasis Exacerbation: A Case Report

Monsour, Elio; Pothen, Joshua; Balaraman, Rama

doi:10.7759/cureus.5824

Cited by 32 publications

(25 citation statements)

References 4 publications

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“…On the other hand, several reports have described the use of IL-17 targeting therapies in this setting. 65 -67 In the study by Johnson et al , a patient with melanoma was treated with pembrolizumab. 66 At 12 weeks there was a notable tumor response, but he also developed significant psoriasis.…”

Section: Psoriasismentioning

confidence: 99%

Cutaneous Immune-Related Adverse Events (irAEs) to Immune Checkpoint Inhibitors: A Dermatology Perspective on Management

et al. 2020

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Immune checkpoint inhibitors have proven to be efficacious for a broad spectrum of solid organ malignancies. These monoclonal antibodies lead to cytotoxic T-cell activation and subsequent elimination of cancer cells. However, they can also lead to immune intolerance and immune-related adverse event (irAEs) that are new and specific to these therapies. Cutaneous irAEs are the most common, arising in up to 34% of patients on PD-1 inhibitors and 43% to 45% on CTLA-4 inhibitors. The most common skin manifestations include maculopapular eruption, pruritus, and vitiligo-like lesions. A grading system has been proposed, which guides management of cutaneous manifestations based on the percent body surface area (BSA) involved. Cutaneous irAEs may prompt clinicians to reduce drug doses, add systemic steroids to the regiment, and/or discontinue lifesaving immunotherapy. Thus, the goal is for early identification and concurrent management to minimize treatment interruptions. We emphasize here that the severity of the reaction should not be graded based on BSA involvement alone, but rather on the nature of the primary cutaneous pathology. For instance, maculopapular eruptions rarely affect <30% BSA and can often be managed conservatively with skin-directed therapies, while Stevens-Johnson syndrome (SJS) affecting even 5% BSA should be managed aggressively and the immunotherapy should be discontinued at once. There is limited literature available on the management of the cutaneous irAEs and most studies present anecdotal evidence. We review the management strategies and provide recommendations for psoriatic, immunobullous, maculopapular, lichenoid, acantholytic eruptions, vitiligo, alopecias, vasculitides, SJS/toxic epidermal necrolysis, and other related skin toxicities.

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Section: Psoriasismentioning

confidence: 99%

Cutaneous Immune-Related Adverse Events (irAEs) to Immune Checkpoint Inhibitors: A Dermatology Perspective on Management

et al. 2020

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“…51 This notion is supported by case reports reporting successful treatment with drugs targeted to established drivers of psoriasis, such as the IL-17 inhibitor secukinumab. 52 Multiple investigations have been undertaken because vitiligo is 1 of the more frequent ircAEs, a fact known since the first clinical trials of ipilimumab in metastatic melanoma. Of note, vitiligo is known to spontaneously appear in patients with melanoma and has also occurred more frequently in experimental treatments with melanoma vaccines.…”

Section: Mechanistic Understanding Of Ircaesmentioning

confidence: 99%

Immune-related cutaneous adverse events due to checkpoint inhibitors

Wang

Kraehenbuehl

Ketosugbo

et al. 2021

Annals of Allergy, Asthma & Immunology

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Cutaneous toxicities are some of the most frequent immune-related cutaneous adverse events (ircAEs) with checkpoint inhibitors.Although the most common ircAEs include nonspecific maculopapular rashes, vitiligo, and lichenoid dermatitis, other ircAEs include bullous dermatosis and psoriasiform dermatitis. Severe cutaneous complications such as drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis are rare.Both cytotoxic T lymphocyteeassociated antigen-4 and programmed cell death protein 1/programmed death ligand 1 inhibitors acting at different stages of T-cell activation can result in a multitude of ircAEs, with T lymphocytes likely playing a key role.Allergists/immunologists need to be familiar with these ircAEs because their incidence will increase with the ever-expanding use of checkpoint inhibitors, and patients will be referred for suspected drug allergies.

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“…However, a loss of tumor response coincided with the initiation of secukinumab treatment [78]. By contrast, two patients with melanoma and non-small cell lung cancer, respectively, treated with secukinumab, resolved their dermatologic irAEs, while therapeutic responses towards the tumor were maintained [76,77]. This highlights the complexity of the immune response in secukinumab and CPI treatments, and the need for additional studies in patients with different cancers and irAEs.…”

Section: Il-17 Inhibitorsmentioning

confidence: 95%

“…• May decrease the recurrence of irAEs and may prevent pre-existing autoimmune flares when used in combination with CPI treatment [25,76,108,111].…”

Section: Tnf Inhibitorsmentioning

confidence: 99%

“…Secukinumab has shown profound therapeutic efficacy in the treatment of cancer patients developing CPI-induced psoriasis [76][77][78]. For instance, a patient with metastatic mismatch repair-deficient colon cancer developed a severe psoriatic rash and gastrointestinal symptoms following exposure to pembrolizumab (anti-PD-1 Ab), and subsequently received secukinumab, which led to complete resolution of irAEs [78].…”

Section: Il-17 Inhibitorsmentioning

confidence: 99%

See 1 more Smart Citation

Predicting and Preventing Immune Checkpoint Inhibitor Toxicity: Targeting Cytokines

Kang

Bluestone

Young

2021

Trends in Immunology

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A Novel Approach to the Treatment of Pembrolizumab-induced Psoriasis Exacerbation: A Case Report

Cited by 32 publications

References 4 publications

Cutaneous Immune-Related Adverse Events (irAEs) to Immune Checkpoint Inhibitors: A Dermatology Perspective on Management

Cutaneous Immune-Related Adverse Events (irAEs) to Immune Checkpoint Inhibitors: A Dermatology Perspective on Management

Immune-related cutaneous adverse events due to checkpoint inhibitors

Predicting and Preventing Immune Checkpoint Inhibitor Toxicity: Targeting Cytokines

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