Paraneoplastic pemphigus manifesting in a patient treated with pembrolizumab for urothelial carcinoma

McNally, Michelle A; Vangipuram, Ramya; Campbell, Matthew T.; Nagarajan, Priyadharsini; Patel, Anisha B.; Curry, Jonathan L.; Heberton, Meghan

doi:10.1016/j.jdcr.2021.02.012

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…Emerging reports on the appearance of newly acquired pemphigus vulgaris or exacerbation of pre-existing pemphigus disease under both PD-1/PD-L1 and CTLA-4 inhibitors are also present in the literature [ 50 , 51 , 52 ]. Cases of paraneoplastic pemphigus have also been reported and are associated mostly with the administration of PD-1/PD-L1 inhibitors [ 53 , 54 ]. Isolated cases of bullous lichenoid dermatitis, dermatitis herpetiformis, and linear IgA bullous dermatosis are also documented [ 2 , 5 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies

Plachouri

Florou

Georgiou

et al. 2023

Cancers

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The advent of immunotherapy and targeted therapies in treating dermatological malignancies has dramatically changed the landscape of dermato-oncology in recent years. Their superior efficacy compared to previous therapeutic options, such as chemotherapy, has resulted in their use in treating devastating malignancies, such as melanoma or unresectable/metastatic basal cell and squamous cell carcinoma. Skin toxicity is a critical safety consideration, among other adverse reactions, that can occur under treatment with these agents. This article aims to summarize the cutaneous side effects of immune checkpoint inhibitors and targeted dermato-oncological therapies. Although the skin side effects of these agents are primarily mild, they can occasionally affect the decision for treatment continuation and the quality of life of the affected patients. Therefore, physicians must be acquainted with the specific cutaneous toxicity profile of such treatments to mitigate their impact on the patients and optimize the overall outcome of dermato-oncological therapy.

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Section: Resultsmentioning

confidence: 99%

Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies

Plachouri

Florou

Georgiou

et al. 2023

Cancers

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“…It is characterized by the production of autoantibodies against various target antigens, mainly envoplakin and periplakin (87), and occurs in the setting of occult or confirmed neoplasms, mostly lymphoproliferative disorders (up to 84% of reported cases) (88). There are also few cases of PNP occurred during immunotherapy (89)(90)(91) whose features suggest a relation between its onset and the oncological therapy instead of the cancer (Supplementary Tables S3, S4). In fact, it has been described in the setting of epithelial origin-carcinomas treated with ICIs, while they account for less than 10% of the classic PNP cases (88)…”

Section: Immune Checkpoint Inhibitor-induced Pv and Paraneoplastic Pe...mentioning

confidence: 99%

“…Furthermore, McNally et al reported a patient treated with pembrolizumab due to a urothelial carcinoma who developed PNP without evidence of active tumor. PNP is almost always associated with an active neoplasm, and it has rarely been reported in patients who are either in remission or have no detectable underlying neoplasm ( 90 ). Also the close temporal relation between ICI initiation and PNP onset suggests a triggering role of immunotherapy as reported in a patient who developed it after 3 months of pembrolizumab therapy due to a 10-year history of a SCC of the tongue ( 89 ).…”

Section: Immunobullous Ciraes–comprehensive Reviewmentioning

confidence: 99%

Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience

et al. 2023

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Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue.

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“…Zudem sind bei bullösen Eruptionen Erkrankungen aus dem Pemphigus-Formenkreis abzugrenzen, welche jedoch unter Immuntherapie eine Rarität darstellen dürften: Lediglich Einzelfallberichte existieren für die Demaskierung oder Manifestation eines paraneoplastischen Pemphigus unter Immuntherapie [37,38]. Dies könnte dadurch erklärt werden, dass der paraneoplastische Pemphigus eine seltene Erkrankung ist und zudem am häufigsten (84 %) bei hämatologischen Erkrankungen vorkommt, die aktuell kein klassisches Einsatzgebiet der Immuntherapie sind [39].…”

Section: Die Erstmanifestation Oder Verschlechterung Einer Psoriasis ...unclassified

Arzneimittelexantheme unter modernen zielgerichteten Therapien – Immuncheckpoint‐ und EGFR‐Inhibitoren

Pospischil

Hoetzenecker

2021

J Deutsche Derma Gesell

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Der zunehmende Einsatz moderner zielgerichteter Therapien führt dazu, dass Dermatologen stetig mit neuartigen kutanen Nebenwirkungen dieser Substanzen konfrontiert werden. Eine rasche Diagnose und Therapie sind notwendig, um die planmäßige Fortführung der onkologischen Therapie zu ermöglichen und eine Beeinträchtigung der Lebensqualität der Patienten zu verhindern. Immuncheckpointund EGFR-Inhibitoren sind häufig eingesetzte zielgerichtete Therapien mit spezifischen kutanen Nebenwirkungsspektren. Exanthematische Hautveränderungen stellen hierbei eine besondere diagnostische Herausforderung dar. Immuncheckpoint-Inhibitoren können vielfältige immunvermittelte kutane Nebenwirkungen hervorrufen; am häufigsten sind dies makulopapulöse, lichenoide oder psoriasiforme Exantheme. Das Auftreten bullöse Autoimmundermatosen und Kollagenose-assoziierter Exantheme ist möglich. Bei atypischen, ausgeprägten oder therapieresistenten exanthematischen Hautveränderungen ist eine dermatologische Abklärung inklusive Hautbiopsie zur genauen Einordnung indiziert. Die Hauptsäule der Therapie stellen topische und systemische Glukokortikoide dar. Unter EGFR-Inhibitor-Therapie sind papulopustulöse Exantheme die häufigste kutane Nebenwirkung, die je nach Substanz bei bis zu 90 % der Patienten innerhalb der ersten beiden Therapiewochen auftreten. Neben topischen Antibiotika und Glukokortikoiden sind systemische Tetrazykline die Therapie der ersten Wahl und können auch prophylaktisch eingesetzt werden.

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Paraneoplastic pemphigus manifesting in a patient treated with pembrolizumab for urothelial carcinoma

Cited by 9 publications

References 8 publications

Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies

Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies

Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience

Arzneimittelexantheme unter modernen zielgerichteten Therapien – Immuncheckpoint‐ und EGFR‐Inhibitoren

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