Management of immune checkpoint inhibitor–induced bullous pemphigoid

Apalla, Zoe; Lallas, Aimilios; Delli, Florentina; Lazaridou, Elizabeth; Papalampou, Stavroula; Apostolidou, Stavroula; Gerochristou, Maria; Rigopoulos, Dimitrios; Stratigos, Alexandros; Nikolaou, Vassiliki

doi:10.1016/j.jaad.2020.05.045

Cited by 21 publications

(26 citation statements)

References 5 publications

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“…65,73 Histopathology is characterised by subepidermal clefting containing fibrin and eosinophils and dermal infiltrates composed of lymphocytes, eosinophils and often neutrophils. 12,69 Direct immunofluorescence (DIF and salt-split DIF), demonstrating linear deposits of IgG and C3 to the epidermal part of the clefting and ELISA studies, mostly detecting BP180 and less often BP230 antibodies, are of high diagnosticvalueand shouldbeincludedin the workup. 59,65,73 Bullous pemphigoid has a profound impact on ICI therapy, resulting in permanent discontinuation in 20%-50% of patients.…”

Section: Autoimmune Bullous Disordersmentioning

confidence: 99%

“…59,65,73 Bullous pemphigoid has a profound impact on ICI therapy, resulting in permanent discontinuation in 20%-50% of patients. 59,65,67,69 Early diagnosis and appropriate intervention seem to facilitate adequate control of BP, limiting treatment withdrawals. ICI-triggered BP may rarely persist for several months after discontinuation, demanding long-term monitoring.…”

Section: Autoimmune Bullous Disordersmentioning

confidence: 99%

“…68 Lichen planus pemphigoides, pemphigus, dermatitis herpetiformis, linear IgA bullous dermatosis or mucous membrane pemphigoid have been much more rarely reported in association with ICIs. 59,67,[69][70][71][72][73][74] Pathogenesis of ICI-induced BP is vague, but it more likely represents a secondary consequence of both B-and T-cell activation in the context of immune stimulation. PD-1 inhibition may activate antibody-secreting B cells and inhibit immunosuppressive B regulatory cells.…”

Section: Autoimmune Bullous Disordersmentioning

confidence: 99%

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European recommendations for management of immune checkpoint inhibitors‐derived dermatologic adverse events. The EADV task force ‘Dermatology for cancer patients’ position statement

Apalla

Nikolaou

Fattore

et al. 2021

Acad Dermatol Venereol

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The introduction of immune checkpoint inhibitors (ICIs) opened a new era in oncologic therapy. The favourable profile of ICIs in terms of efficacy and safety can be overshadowed by the development of immune-related adverse events (irAEs).Dermatologic irAEs (dirAEs) appear in about 40% of patients undergoing immunotherapy and mainly include maculopapular, psoriasiform, lichenoid and eczematous rashes, auto-immune bullous disorders, pigmentary disorders, pruritus, oral mucosal lesions, hair and nail changes, as well as a few rare and potentially life-threatening toxicities. The EADV task force Dermatology for Cancer Patients merged the clinical experience of the so-far published data, incorporated the quantitative and qualitative characteristics of each specific dirAEs, and released dermatology-derived, phenotypespecific treatment recommendations for cutaneous toxicities (including levels of evidence and grades of recommendation). The basic principle of management is that the interventions should be tailored to serve the equilibrium between patients' relief from the symptoms and signs of skin toxicity and the preservation of an unimpeded oncologic treatment.

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Section: Autoimmune Bullous Disordersmentioning

confidence: 99%

Section: Autoimmune Bullous Disordersmentioning

confidence: 99%

Section: Autoimmune Bullous Disordersmentioning

confidence: 99%

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European recommendations for management of immune checkpoint inhibitors‐derived dermatologic adverse events. The EADV task force ‘Dermatology for cancer patients’ position statement

Apalla

Nikolaou

Fattore

et al. 2021

Acad Dermatol Venereol

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“…The clinical presentation of bullous disorders includes pruritus, tense vesicles/bullae on the trunk and extremities as well as oral erosions, and urticarial lesions. The oncologists is essential for the optimal treatment decision [25].…”

Section: B Bullous Eruptionsmentioning

confidence: 99%

Cutaneous Adverse Events of Immune Checkpoint Inhibitors: A Literature Review

Apalla

Papageorgiou

Lallas

et al. 2021

Dermatol Pract Concept

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Immune checkpoint inhibitors (CPIs) are targeted molecules that modulate the immune system, assist with self-tolerance, and minimize collateral tissue damage when immune responses are activated. Although they are characterized by a favorable risk/benefit ratio, immune checkpoint blockade has been associated with a new subset of autoimmune-like toxicities, named immune-related adverse events (irAE). Dermatologic reactions are among the most prevalent irAE triggered by CPIs. In a majority of cases they are self-limiting and readily manageable. However, it is not uncommon that they result in severe skin involvement and impairment of patients’ quality of life. Awareness of the spectrum of cutaneous irAEs is mandatory for every clinician involved in the management of oncologic patients. The role of the dermatologists is essential because early recognition and appropriate management of skin toxicity may prevent dose modifications and discontinuation of CPIs. The latter is particularly relevant, considering that recent data suggest favorable oncologic response in patients developing irAEs.

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“…1 Several cases of bullous pemphigoid (BP) triggered by anti-PD-1/PD-L1 therapy have been reported. [2][3][4][5][6][7] In this study, we sought to compile all the French cases of BP associated with anti-PD-1/PD-L1 therapy to describe their characteristics, treatments, impact on cancer therapy and course of the tumour.…”

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confidence: 99%

Clinical, biological and histological characteristics of bullous pemphigoid associated with anti‐PD‐1/PD‐L1 therapy: A national retrospective study

Juzot

Sibaud

Amatore

et al. 2021

Acad Dermatol Venereol

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Dear Editor, Costello syndrome is a rare genetic syndrome. The mode of inheritance is autosomal dominant; however, most cases are sporadic. Mutations in the HRAS gene lead to a dysregulation of the Ras/mitogen-activated protein kinase (MAPK) pathway. 1 These genetic diseases are known as RASopathies and include Costello syndrome, LEOPARD syndrome, Noonan syndrome, cardiofaciocutaneous syndrome, neurofibromatosis type 1 and Legius syndrome. Patients with RASopathies often suffer from mental retardation, cardiovascular disease, short stature, macrocephaly

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Management of immune checkpoint inhibitor–induced bullous pemphigoid

Cited by 21 publications

References 5 publications

European recommendations for management of immune checkpoint inhibitors‐derived dermatologic adverse events. The EADV task force ‘Dermatology for cancer patients’ position statement

European recommendations for management of immune checkpoint inhibitors‐derived dermatologic adverse events. The EADV task force ‘Dermatology for cancer patients’ position statement

Cutaneous Adverse Events of Immune Checkpoint Inhibitors: A Literature Review

Clinical, biological and histological characteristics of bullous pemphigoid associated with anti‐PD‐1/PD‐L1 therapy: A national retrospective study

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