Management of Cutaneous Immune-Related Adverse Events in Patients With Cancer Treated With Immune Checkpoint Inhibitors

Abstract

IMPORTANCEThere exists a paucity of literature that summarizes the effective management of cutaneous immune-related adverse events (cirAEs) in patients with cancer who are receiving immune checkpoint inhibitors (ICIs). Most published articles are small case series from a single institution. To our knowledge, the spectrum of possible treatments has not been systematically reviewed to highlight the breadth of options when caring for patients with cirAEs.OBJECTIVE To further characterize the development of subtypes of cirAEs in patients with cancer treated with ICIs and provide recommendations on optimal treatment regimens based on the current literature.EVIDENCE REVIEW A search was performed in PubMed, Embase European, Web of Science, and Google Scholar on June 26, 2020, according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, limited to the years 2010 to 2020. Articles that met predetermined inclusion criteria (published between January 1, 2010, and June 1, 2020; written in the English language; and original articles, brief reports, case reports, and research letters that reported primarily on cirAE management) were selected, and data were abstracted. Articles that met the scope of the review were also added from reference lists. When possible, the results of studies that addressed a similar question were combined quantitatively. FINDINGS In total, 138 studies (87 from the aforementioned literature search and 51 additional studies pulled from the reference lists of included articles) were included that reported on 879 cirAEs. The subtypes of cirAEs included maculopapular, pruritus, lichenoid, immunobullous, psoriasiform, granulomatous, erythema multiforme or Stevens Johnson Syndrome, drug rash with eosinophilia and systemic symptoms, connective tissue disease, hair, oral, and miscellaneous. Treatments for cirAEs included a combination of topical corticosteroids, systemic corticosteroids, steroid-sparing agents, and discontinuation or cessation of immunotherapy.CONCLUSIONS AND RELEVANCE This systematic review found that treatment with ICIs was associated with many types of skin toxic effects, each with unique treatment options beyond current published guidelines. Further research into key differences between subtypes is critical to improve the care provided to patients with cancer.

Global research trends on the links between gut microbiota and cancer immunotherapy: A bibliometric analysis (2012-2021)

“…Immunotherapy has been shown to be effective in oncology treatment ( 4 , 5 ), whether used alone or in combination with other anti-tumor methods ( 6 , 7 ), significantly improving the health-related quality of life in cancer patients. However, its efficacy is still limited by the heterogeneity of the patients’ immune response and the heterogeneity among different tumors ( 8 , 9 ), and some patients will experience primary or acquired drug resistance and related adverse events ( 10 , 11 ) during treatment, which greatly hinder the widespread clinical application of anti-tumor immunotherapy.…”

Immune Checkpoint Inhibitor Rechallenge After Prior Immune Toxicity

“…Fortunately, we now have effective therapies to treat irAEs. Skin rash of mild severity can often be controlled with topical therapy alone [ 20 ], anti-diarrheal medications can be used for mild colitis/diarrhea [ 21 ], and many of the endocrinopathies can be treated with hormone replacement [ 22 ]. As a result, there is an increasing number of patients who experience irAEs of mild severity that can continue ICIs without a period of discontinuation.…”

The value of the multidisciplinary team in metastatic renal cell carcinoma: Paving the way for precision medicine in toxicities management

“…Also, life-threating conditions like Stevens–Johnson syndrome/toxic epidermal necrolysis and the drug reaction with eosinophilia and systemic symptoms (DRESS) may occur ( 80 ). In order to avoid severe reactions that can even be lethal for the patient, it is really important to make the right diagnosis very quickly, taking into account appearance and timing and skin involvement, to understand the best pretreatment and or desensibilization, to avoid oncologic treatment discontinuation, and to obtain the best efficacy, a high compliance, and the best quality of life ( 81 , 82 ). In case of severe reactions (G3–G4 cutaneous toxicity, with diffused eruption), systemic corticosteroids, withholding ICIs, and skin biopsy to exclude other causes and verify the grade of epidermic necrosis should be recommended.…”