Cutaneous immune-related adverse events to checkpoint inhibitors

Malviya, Neeta; Tattersall, Ian W.; Leventhal, Jonathan S.; Alloo, Allireza

doi:10.1016/j.clindermatol.2020.06.011

Cited by 30 publications

(55 citation statements)

References 104 publications

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“…Immune-related cutaneous AEs are characterized as inflammatory dermatoses, bullous dermatoses, and severe cutaneous adverse reactions (SCARs), according to the CTCAE. 7 The median time to onset of skin toxicities is 4 weeks, but can range broadly from 2 to 150 weeks. [8][9][10] Rash or inflammatory dermatitis irAEs encompass erythema multiforme, lichenoid, eczematous, psoriasiform, morbilliform, and palmoplantar erythrodysesthesia, or hand-foot syndrome.…”

Section: Clinical Questionmentioning

confidence: 99%

“…There were nine ongoing trials identified (Table13) that would be eligible for inclusion in the update of this recommendation report in the future.ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care, and that all patients should have the opportunity to participate.ADDITIONAL RESOURCESMore information, including a supplement with additional evidence tables, slide sets, and clinical tools and resources, is available at www.asco.org/supportive-care-guidelines. Patient information is available at www.cancer.net.AFFILIATIONS1 University of Michigan Health System, Ann Arbor, MI2 Beaumont Hospital, Dublin, Ireland 3 Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 4 Memorial Sloan Kettering Cancer Center, New York, NY5 American Society of Clinical Oncology, Alexandria, VA6 MD Anderson Cancer Center, Houston, TX7 Washington University, St Louis, MO…”

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confidence: 99%

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Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

Schneider

Naidoo

Santomasso

et al. 2021

JCO

958

804

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PURPOSE To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS Recommendations for specific organ system–based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines .

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Section: Clinical Questionmentioning

confidence: 99%

mentioning

confidence: 99%

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

Schneider

Naidoo

Santomasso

et al. 2021

JCO

958

804

View full text Add to dashboard Cite

show abstract

“…If patients are concerned cosmetically, topical steroids, topical vitamin D analogues, and topical calcineurin inhibitors can be considered for the treatment. [35][36][37] One patient who used ipilimumab had erythematous patches without scale on intertriginous areas. Lesions had well-defined borders but it was not be possible to differentiate intertrigo and inverse psoriasis.…”

Section: Discussionmentioning

confidence: 99%

Dermatological side effects of immunotherapy drugs and targeted cancer therapies: Importance of dermatology and oncology collaboration

Çelik

Aydemir

Engın

et al. 2020

J Oncol Pharm Pract

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Introduction Novel anti-cancer drugs such as targeted cancer therapies and immune check-point inhibitors (ICIs) have adverse events, especially concerning the skin. The aim of this study is to report an overview of the commonly consulted dermatological side effects of ICIs and targeted cancer therapies in clinical practice, along with their management. Methods In this single-center study, we evaluated consecutive oncological patients who were referred from the oncology outpatient clinic to the dermatology outpatient clinic due to skin side effects of ICIs and targeted therapies. All patients were examined and treated at the same day of referral by experienced dermatologists. Patient characteristics, clinical findings, diagnostic workups and treatments were retrieved from outpatient records. Results Sixty three patients were enrolled. Most common diagnoses were lung carcinoma, melanoma and colon carcinoma. Fifty patients (79%) were using targeted therapies while 13 (21%) were using ICIs. Xerosis was the most common side effect (44%), followed by acneiform rash, paronychia, eczema and pruritus. Majority of the side effects were grade 2 and 3. Psoriasis was a common side effect of ICIs. One patient had a newly developed dysplastic nevus on vemurafenib treatment. Oncological treatment was not withheld in any of the patients. Conclusions This study revealed the most commonly consulted skin side effects of novel anti-cancer drugs and their management in daily practice. We underlie the importance of collaborative work of oncology and dermatology professionals as early management of cutaneous side effects of targeted therapies and ICIs improves patient outcomes.

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“…By contrast, cases occurring in patients with cancers other than melanoma, such as lung adenocarcinoma, cholangiocarcinoma, renal cell carcinoma, squamous cell carcinoma, transitional cell carcinoma, and hematologic malignancies ( Figure 7B ), are less commonly reported. 7 Occurrence of depigmentation during ICI therapy is significantly associated with a favorable prognosis such as higher survival rates. 50 Vitiligo is more frequently induced during anti-PD-1 therapy than during anti-CTLA-4 therapy.…”

Section: Various Mucocutaneous Disordersmentioning

confidence: 99%

“… 74 Vasculitis (cutaneous leukocytoclastic vasculitis), rheumatic diseases (systemic and cutaneous lupus erythematosus (acute, subacute, and chronic), dermatomyositis, Sjogren's syndrome, and autoimmune fasciitis), and rare forms of skin lesions mimicking erythema annulare centrifugum or pityriasis rubra pilaris, have been reported. 6 , 7 Both benign and malignant skin tumors, such as keratoacanthoma, porokeratosis, actinic keratosis, squamous cell carcinoma, and pseudolymphoma, have been reported. 6 Eruptive keratoacanthoma showed spontaneous regression following nivolumab treatment.…”

Section: Various Mucocutaneous Disordersmentioning

confidence: 99%

Skin Manifestation Induced by Immune Checkpoint Inhibitors

Yamamoto¹

2022

CCID

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In accordance with recent therapeutic progress of immune checkpoint inhibitors for certain cancers, various disorders are induced as immune-related adverse events (irAEs) affecting the skin, gut, thyroid gland, lung, and liver. Among such irAEs, mucocutaneous manifestation is the most common. Cutaneous manifestations are categorized into several groups, ie, inflammatory reactions, immunobullous reactions, alterations of epidermal keratinocytes, and alterations of epidermal melanocytes; however, there are additionally various cutaneous toxicities, unclassified into those groups. Blocking of programmed cell death 1 (PD-1)/programmed cell death ligand 1(PDL1) can lead to the induction of autoimmune reaction, via activation of cytotoxic T cells, inhibition of regulatory T cell function, and alteration of cytokine balance. Similarly, blockade of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) reduces the suppressive function of regulatory T cells. Due to those mechanisms, various autoimmune conditions can be induced, in addition to nonspecific drug eruptions. Dermatologists should be aware of various types of those mucocutaneous manifestations, either common or rare, as well as the management of such conditions. Herein, various mucocutaneous manifestations of irAEs and cases involving Japanese patients have been described, based on a single institute’s experience.

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Cutaneous immune-related adverse events to checkpoint inhibitors

Cited by 30 publications

References 104 publications

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

Dermatological side effects of immunotherapy drugs and targeted cancer therapies: Importance of dermatology and oncology collaboration

Skin Manifestation Induced by Immune Checkpoint Inhibitors

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