Immune-Mediated Toxic Epidermal Necrolysis

Abstract

The treatment of melanoma has advanced over time with the latest modalities being immune checkpoint blockade by programmed death receptor 1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors. Programmed death receptor 1 inhibitors have been noted to cause multisystem adverse reactions. The dermatological adverse events can range from pruritus to severe toxic epidermal necrolysis. We report a fatal case of toxic epidermal necrolysis secondary to nivolumab therapy. Checkpoint inhibitors are becoming the standard treatment option in many malignancies. Their safety profile is still evolving as more cases are being reported. Many individuals who are immunocompromised or undergoing concomitant treatment with combination therapy could develop significant overlapping toxicities. Physicians must be vigilant for dermatological complications that lead to opportunistic infections and sepsis.

Cemiplimab for Locally Advanced and Metastatic Cutaneous Squamous-Cell Carcinomas: Real-Life Experience from the French CAREPI Study Group

“…One cemiplimab-related death from toxic epidermal necrolysis occurred. About 20 Stevens–Johnson syndrome/toxic epidermal necrolysis cases have been reported with other inhibitors of PD-1 or its ligand [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Toxic epidermal necrolysis is responsible for high mortality [ 56 ].…”

Oral manifestations of immune‐related adverse events in cancer patients treated with immune checkpoint inhibitors

“…Stevens-Johnson Syndrome (SJS)-like and Toxic Epidermal Necrolysis (TEN)-like reactions have been reported in patients on pembrolizumab and nivolumab, as well as combination treatment with nivolumab and ipilimumab (Keerty et al, 2020;Logan et al, 2020).…”

“…Stevens‐Johnson Syndrome (SJS)‐like and Toxic Epidermal Necrolysis (TEN)‐like reactions have been reported in patients on pembrolizumab and nivolumab, as well as combination treatment with nivolumab and ipilimumab (Keerty et al, 2020; Logan et al, 2020). These reactions have presented 3 days to 7 months following initiation of ICI therapy (Cai et al, 2020; Goldinger et al, 2016; Hwang et al, 2019; Keerty et al, 2020; Maloney et al, 2020; Riano et al, 2020; Saw et al, 2017).…”

“…Due to the severity of these conditions, nearly all patients require hospitalization (often in the intensive care or burn unit), multidisciplinary management, and permanent discontinuation of immunotherapy (Cai et al, 2020; Goldinger et al, 2016; Hwang et al, 2019; Keerty et al, 2020; Logan et al, 2020; Maloney et al, 2020; Riano et al, 2020; Saw et al, 2017). Treatment has included systemic corticosteroids, cyclosporine, IVIG, infliximab, mycophenolate mofetil, plasmapheresis, and granulocyte colony‐stimulating factor (G‐CSF) (Cai et al, 2020; Goldinger et al, 2016; Hwang et al, 2019; Keerty et al, 2020; Logan et al, 2020; Maloney et al, 2020; Riano et al, 2020; Saw et al, 2017). Etanercept has recently emerged as a promising therapy in SJS/TEN, but its use has not been reported in the context of an irAE (Tsai et al, 2021).…”

“…Stevens‐Johnson Syndrome (SJS)‐like and Toxic Epidermal Necrolysis (TEN)‐like reactions have been reported in patients on pembrolizumab and nivolumab, as well as combination treatment with nivolumab and ipilimumab (Keerty et al, 2020; Logan et al, 2020). These reactions have presented 3 days to 7 months following initiation of ICI therapy (Cai et al, 2020; Goldinger et al, 2016; Hwang et al, 2019; Keerty et al, 2020; Maloney et al, 2020; Riano et al, 2020; Saw et al, 2017). In several cases, SJS‐like and TEN‐like reactions were preceded by prodromal skin rashes that subsequently evolved into mucosal and skin denudation more characteristic of the conditions (Cai et al, 2020; Goldinger et al, 2016; Keerty et al, 2020; Maloney et al, 2020).…”