Concomitant Radiation Recall Dermatitis and Radiation Recall Pneumonitis Induced by Pembrolizumab

Wang, Yan-Yang; Xingcang, Tian; Zhu, Ling; Bai, Xuehong; Zhao, Ren

doi:10.1016/j.jtho.2020.05.014

Cited by 12 publications

(8 citation statements)

References 5 publications

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“…This rash was not observed on subsequent cycles and regressed after treatment with topical steroid therapy. 1 Another case of RRD after pembrolizumab is reported by Wang et al 8 where the patient developed a confluent erythematous rash with superficial edema limited to the previously irradiated supraclavicular area 3 days after the start of immunotherapy. This was the first case of concomitant RRD along with lung involvement, characterized as radiation recall pneumonitis.…”

Section: Discussionmentioning

confidence: 97%

Radiation Recall Dermatitis Following Treatment With Pembrolizumab: A Case Report and Review of the Literature

Sandhu

Kumar

Deck

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Radiation recall dermatitis is an inflammatory reaction of the skin that may infrequently occur in areas of the skin that have been previously treated with radiation therapy. This is thought to be due to a triggering agent administered after radiation therapy which leads to an acute inflammatory reaction, manifesting as a skin rash. We present the case of a 58-year-old male with recurrent invasive squamous cell carcinoma of the tongue, previously treated with chemotherapy and radiation therapy, who presented with progression of his disease. He was treated with pembrolizumab and subsequently developed a new-onset facial rash over the previously treated radiation field. The distribution of the rash was suggestive of radiation recall dermatitis. A biopsy showed dermal necrosis without evidence of dermatitis, vasculitis, or infectious process. This case highlights the incidence of a rare complication of immune checkpoint inhibitor therapy and emphasizes the need for careful monitoring for radiation recall dermatitis.

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Section: Discussionmentioning

confidence: 97%

Radiation Recall Dermatitis Following Treatment With Pembrolizumab: A Case Report and Review of the Literature

Sandhu

Kumar

Deck

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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show abstract

“…These agents trigger, or “recall”, an acute inflammatory response in an area previously treated with radiotherapy. RRD falls into a larger category of Radiation Recall Reactions which can include pneumonitis, gastritis, myositis and more, though dermatitis is the most common ( McKay and Foster, 2021 , Wang et al, 2020 ). Biopsies of such skin reactions have shown histopathological evidence of acute and chronic inflammation, likely due to damage by reactive oxygen species and cytokine release ( McKay & Foster, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Radiation recall dermatitis during treatment of endometrial cancer with pembrolizumab plus lenvatinib: A case report

Heisler

Tunnage²,

Growdon³

2023

Gynecologic Oncology Reports

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“…When ICI therapy was started after completion of RT (n=12), cutaneous reactions occurred in a median of approximately 20 days from the start of ICI therapy and a median of 77 days from the last RT. 23,[27][28][29][30][31][32][33][34][35] When RT was started while on ICI therapy (n=9), the cutaneous reactions occurred in a median of 73 days from the start of ICI therapy and a median of 17.5 days from the last RT. 25,26,[37][38][39][40][41][42] There was one reported case of a cutaneous reaction occurring when ICI therapy was started while patient was already on RT therapy occurring in 21 and 28 days from start of ICI and RT, respectively.…”

Section: Skin Reaction Management Histologymentioning

confidence: 99%

Review of Immune Checkpoint Inhibitors and Radiotherapy Related Skin Toxicities

Kaszycki¹,

Leventhal²

2021

J Dermatol & Skin Sci

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Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, and their use in combination with radiation therapy (RT) has become increasingly utilized to optimize positive outcomes. The cutaneous adverse reactions from RT as well as ICIs are both well documented; however, in combination these cutaneous toxicities can be exacerbated. ICIs and RT may work synergistically to create an enhanced immune response against the tumor cells. This synergistic effect has been reported to occur both locally at the site of RT, as well as systemically via an abscopal effect. Fortunately, this combination of treatment does not increase the incidence of cutaneous reactions, although several cases have reported enhanced skin toxicity at the site of RT. RT is thought to create an ‘immunocompromised skin district’ or localized immune dysregulation in irradiated skin. This review summarizes previously published case reports and discusses the cutaneous adverse reactions from ICI and RT combination therapy. Properly identifying ICI and RT induced skin reactions depends on several factors including patient history, sequence of therapies, timing of reaction, and histological findings. Skin reactions from combination therapy can range in severity and include ICI-induced radiation recall dermatitis, as well as uncommon presentations of Stevens-Johnson syndrome, lichen planus, and bullous pemphigoid which are localized to or enhanced within areas of prior radiation exposure. It is important for oncologists and dermatologists alike to be aware of the spectrum of reactions associated with ICI and RT.

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Concomitant Radiation Recall Dermatitis and Radiation Recall Pneumonitis Induced by Pembrolizumab

Cited by 12 publications

References 5 publications

Radiation Recall Dermatitis Following Treatment With Pembrolizumab: A Case Report and Review of the Literature

Radiation Recall Dermatitis Following Treatment With Pembrolizumab: A Case Report and Review of the Literature

Radiation recall dermatitis during treatment of endometrial cancer with pembrolizumab plus lenvatinib: A case report

Review of Immune Checkpoint Inhibitors and Radiotherapy Related Skin Toxicities

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