Atezolizumab-Induced Stevens-Johnson Syndrome in a Patient with Non-Small Cell Lung Carcinoma

Chirasuthat, Phatcharawat; Chayavichitsilp, Pamela

doi:10.1159/000492172

Cited by 32 publications

(15 citation statements)

References 10 publications

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“…Whenever severe erosive or bullous drug eruptions occur on checkpoint inhibitor therapy, it is essential to diagnose such reactions correctly. Table 1 provides a summary of and commentary to all cases of SJS/TEN and TEN-like reactions on checkpoint inhibitor therapy (CTLA4, PD-1 and PD-L1) (n = 14) published in German, English, and French and listed on PubMed [9][10][11][12][13][14][15][16][17][18][19][20][21]. According to our case analysis, it does seem much more likely that many of the published cases actually represented bullous lichenoid drug eruptions (some of which were associated with lichenoid mucosal involvement) or cases of isolated erosive lichenoid mucositis, as well as cases of epidermolytic reactions in areas previously irradiated (radiation recall).…”

Section: Clinical Lettermentioning

confidence: 99%

Severe bullous skin eruptions on checkpoint inhibitor therapy – in most cases severe bullous lichenoid drug eruptions

Reschke

Mockenhaupt

Simon

et al. 2019

J Deutsche Derma Gesell

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Section: Clinical Lettermentioning

confidence: 99%

Severe bullous skin eruptions on checkpoint inhibitor therapy – in most cases severe bullous lichenoid drug eruptions

Reschke

Mockenhaupt

Simon

et al. 2019

J Deutsche Derma Gesell

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“…The disruption of this equilibrium by the use of these molecules may mediate inflammation and self-destruction of the keratinocytes. 11,12 Management of SJS/TEN consists of early recognition of symptoms and discontinuation of the culprit drug. Current treatments are mainly supportive with short-term pulsed corticosteroids, cyclosporine and anti-TNF as first line agents.…”

Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis associated with pembrolizumab

Cai

Lecours

Adam

et al. 2019

J Oncol Pharm Pract

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Introduction Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous drug eruptions characterized by epidermal detachment. Pembrolizumab is a monoclonal antibody that binds to the programmed death-1 receptor, and it has been associated with numerous cutaneous adverse side-effects, including Stevens-Johnson syndrome. Case report We describe a 63-year-old male with metastatic lung adenocarcinoma who developed a rapidly progressing maculopapular rash three days after a first dose of pembrolizumab. On day 16, the rash affected more than 80% of body surface area with detachment of large sheets of necrolytic epidermis in 30–40% of body surface area. However, the patient only presented with mild mucosal involvement. Histopathologic examination of a skin biopsy showed a subepidermal blister with overlying prominent full thickness epidermal keratinocytic necrosis and a superficial perivascular infiltrate of lymphocytes. A toxic epidermal necrolysis secondary to pembrolizumab was then diagnosed. Management and outcome: In addition to supportive cares, the patient received corticosteroids and cyclosporine. The patient responded rapidly to the immunosuppressant therapy, and nearly complete re-epithelialization was achieved 24 days after the start of the reaction. Discussion In our review of the literature, 15 other cases of Stevens-Johnson syndrome/toxic epidermal necrolysis were reported with programmed death-1/programmed cell death ligand-1 inhibitors. To our knowledge, this is the first case of toxic epidermal necrolysis secondary to pembrolizumab published in the literature. The American Society of Clinical Oncology guidelines suggest that cyclosporine, in addition to corticosteroids, be initiated when toxic epidermal necrolysis is suspected. Clinicians should be aware of this rare dermatological emergency with the increasing use of pembrolizumab in oncology.

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“…In case of pruritus involvement, supportive care such as cold compresses and oatmeal baths might alleviate symptoms (Sgambato et al, 2016). Although dermatologic irAEs are usually mild to moderate in severity, rare exfoliative conditions such as Stevens-Johnson syndrome/toxic epidermal necrolysis (Chirasuthat and Chayavichitsilp, 2018) have been observed in Asian patients and can be fatal (Puzanov et al, 2017). In such cases, PD-1/PD-L1 blockade should be permanently discontinued.…”

Section: Management Of Immune-related Adverse Events In Cancer Patienmentioning

confidence: 99%

Management of Adverse Events in Cancer Patients Treated With PD-1/PD-L1 Blockade: Focus on Asian Populations

Yang

et al. 2019

Front. Pharmacol.

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The interaction between programmed cell death protein 1 (PD-1) and its ligand programmed death-ligand 1 (PD-L1) induces exhaustions of cytotoxic lymphocytes in the tumor microenvironment, which facilitates tumor immune evasion. PD-1/PD-L1 blockade therapy, which prevents the receptors and ligands from binding to each other, disrupts the T-cell exhaustion signaling, thereby increasing antitumor immunity. Inspiringly, it has revolutionized the treatment of many different types of cancers including non-small-cell lung carcinoma, melanoma, lymphoma, and so on. However, with the intention of generating an antitumor immune response, PD-1/PD-L1 blockade may also lead to a spectrum of side effects. The profile of adverse events (AEs) of PD-1/PD-L1 blockade is not exactly the same with other immune checkpoint blockades, such as blockade of cytotoxic T-lymphocyte-associated protein 4. Although cutaneous, gastrointestinal, and pulmonary systems are common victims, AEs of PD-1/PD-L1 blockade might occur in any other organ system of the human body. These toxicities can be life-threatening if not managed promptly, and proper treatment intervention is imperative for optimal control and prevention of severe damage. Currently, clinical practice for the management of AEs in PD-1/PD-L1 blockade remains sporadic and variable. The majority of initial clinical trials were carried out in Caucasians. The trials of multiple races usually included a small portion of Asian participants, and results were calculated and interpreted for the entire included subjects without any race-specific conclusions. Therefore, the information on PD-1/PD-L1 blockade in Asians is far from systematic or comprehensive. Recently, as the results of clinical trials of anti-PD-1/PD-L1 agents in Asian populations have been gradually released, we summarized current evidence with a specific focus on the Asian population, hoping to outline strategies and offer guidance on the management of AEs in cancer patients treated with PD-1/PD-L1 blockade in the Asian world.

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Atezolizumab-Induced Stevens-Johnson Syndrome in a Patient with Non-Small Cell Lung Carcinoma

Cited by 32 publications

References 10 publications

Severe bullous skin eruptions on checkpoint inhibitor therapy – in most cases severe bullous lichenoid drug eruptions

Severe bullous skin eruptions on checkpoint inhibitor therapy – in most cases severe bullous lichenoid drug eruptions

Toxic epidermal necrolysis associated with pembrolizumab

Management of Adverse Events in Cancer Patients Treated With PD-1/PD-L1 Blockade: Focus on Asian Populations

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