Bullous pemphigoid associated with the 480-mg nivolumab dose in a patient with metastatic renal cell carcinoma

Palla, Amruth R.; Smith, Emily H.; Doll, Donald C.

doi:10.2217/imt-2019-0027

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…Thus, higher flat-dose of nivolumab represents a convenient option to reduce the attendance to health care facilities, especially for those patients whose body weight is around 80 kg. However, another group have reported a case of bullous pemphigoid associated with extended-interval flat 480 mg nivolumab dose regimen in a patient with a metastatic renal carcinoma who had been previously treated with 240 mg Q2W for 2 years without safety concerns (16). While our case report and others suggest these extendedinterval higher flat-dose regimens may increase or alter the propensity for ICI irAEs, clinical trial data does suggest these regimens have similar efficacy and safety profiles and are reasonable options for patients.…”

Section: Discussionmentioning

confidence: 99%

Immune-checkpoint inhibitors for lung cancer patients amid the COVID-19 pandemic: a case report of severe meningoencephalitis after switching to an extended-interval higher flat-dose nivolumab regimen

Pous¹,

Izquierdo²,

Cucurull³

et al. 2021

Transl Lung Cancer Res

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Alternative dosage regimens for some anticancer therapies have been proposed in the midst of the SARS-COV-2 pandemic in order to protect the patients from attending to health care facilities. Flatdosing of several immune-checkpoint inhibitors (ICIs), including nivolumab, have been established. Although generally well tolerated with no new safety signals, new dosages can associate novel individual toxicities. As the use of ICIs is increasing in cancer patients, the present case report is a reminder for clinicians of potential novel toxicities, as well as the need for an interdisciplinary approach for their recognition and treatment. We report the occurrence of a severe neurologic toxicity in a patient with non-small cell lung cancer (NSCLC) who developed should be changed to which occurred after two doses of extended higher interval flat-dose nivolumab despite two years of clinical stability on prior nivolumab regimen. Patient developed fever, language impairment and altered mental status. The work-up tests excluded other potential causes and the most likely diagnosis was meningoencephalitis. Fortunately, with medical treatment, which consisted of high dose steroids, the patient recovered to his baseline situation and symptoms did not recurred, even though nivolumab was resumed. Alternate ICI regimens may have unique immune-related adverse event profiles.

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Section: Discussionmentioning

confidence: 99%

Immune-checkpoint inhibitors for lung cancer patients amid the COVID-19 pandemic: a case report of severe meningoencephalitis after switching to an extended-interval higher flat-dose nivolumab regimen

Pous¹,

Izquierdo²,

Cucurull³

et al. 2021

Transl Lung Cancer Res

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“…In one case report BP developed after the patient was transitioned to a higher dose of nivolumab. Another case report showed improvement in BP after switching from nivolumab to pembrolizumab [18] . Consequently, immunotherapy should not be permanently discontinued without the trial of the previously tolerated dose or frequency or different immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Nivolumab-induced severe bullous pemphigoid in a patient with renal cancer: a case report and literature review

Wu¹,

Palvai²,

Jalil³

2020

JCMT

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With the widespread use of immunotherapy in numerous solid tumours, immunotherapy-related adverse events (irAEs) have started to emerge and bring new challenges for clinicians to manage. Among established irAEs, dermatologic toxicity is one of the most common toxicities; it is often mild but can be severe and potentially life-threatening, such as bullous pemphigoid. Here, we report a case of nivolumab-mediated severe, extensive, refractory bullous pemphigoid involving both skin and oral mucosa in a patient with metastatic renal cancer. We also summarise a list of selected case reports of immunotherapy-induced bullous pemphigoid by literature review. We highlight various presentations, investigations and managements of this type of skin irAEs. Meantime, we would like to discuss the correlation of skin irAEs incidence rate with immunotherapy drug benefit and resistance.

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“…Clinical incidence : Twenty-nine cases of bullous pemphigoid were reported with the anti-PD-1/PD-L1 immunotherapy where thirteen cases were associated with pembrolizumab [84][85][86][87][88][89][90][91][92][93] , twelve with nivolumab [92][93][94][95][96][97] , three with atezolizumab 93,98,99 , and one with durvalumab therapy 93 . The occurrence of BP was found in 16-30% of patients receiving anti-PD-1/PD-L1 immunotherapy and is generally longer than that of other cutaneous toxicities.…”

Section: Pathogenesismentioning

confidence: 99%

“…A total of four cases with nivolumab (n=1) and pembrolizumab (n=3) developed non-bullous pemphigoid (NBP), severe pruritus with eczematous patches or urticarial plaques 92 . A patient with metastatic RCC developed bullous pemphigoid subsequently with a single dose of 480 mg iv of nivolumab therapy 96 .…”

Section: Pathogenesismentioning

confidence: 99%

Adverse Cutaneous Outbreaks by programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) immune checkpoint inhibitors: A Review.

Bhardwaj,

Chiu,

Sah

2024

Preprint

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The therapeutic use of humanized monoclonal anti-programmed cell death 1 (PD-1) (pembrolizumab, and nivolumab) and anti-programmed cell death ligand1 (PD-L1) (atezolizumab, avelumab, durvalumab) as potent anticancer therapies is rapidly increasing. The mechanism of signaling of anti-PD-1/PD-L1 involves triggering cytotoxic CD4+/CD8+T cell activation, which induces specific immunologic adverse events. The anti-PD-1/PD-L1 drugs can cause numerous cases of cutaneous reactions, hence these toxicities are characterized as the most frequent immune-related adverse events (irAEs). The majority of cutaneous irAEs triggered by immune checkpoint inhibitors range from nonspecific eruptions to detectible skin manifestations, which may be self-limiting and present an acceptable skin toxicity profile, while some may produce mild to life-threatening complications. This review aims to illuminate the associated cutaneous adverse events related to the drugs used in oncology along with the relevant mechanism(s). With this review article, an overview of the various adverse cutaneous manifestations of anti-PD-1 (pembrolizumab, and nivolumab) and anti-PD-L1 (atezolizumab, avelumab, durvalumab) therapy, as well as suggestions, have been provided, so that their recognition at early stages could help in better management and would prevent treatment discontinuation.

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Bullous pemphigoid associated with the 480-mg nivolumab dose in a patient with metastatic renal cell carcinoma

Cited by 9 publications

References 10 publications

Immune-checkpoint inhibitors for lung cancer patients amid the COVID-19 pandemic: a case report of severe meningoencephalitis after switching to an extended-interval higher flat-dose nivolumab regimen

Immune-checkpoint inhibitors for lung cancer patients amid the COVID-19 pandemic: a case report of severe meningoencephalitis after switching to an extended-interval higher flat-dose nivolumab regimen

Nivolumab-induced severe bullous pemphigoid in a patient with renal cancer: a case report and literature review

Adverse Cutaneous Outbreaks by programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) immune checkpoint inhibitors: A Review.

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