Prevalence of dermatological toxicities in patients with melanoma undergoing immunotherapy: Systematic review and meta-analysis

Abstract

Background Checkpoint inhibitors have revolutionized advanced melanoma care; however, their cutaneous side effects have not been definitively elucidated. Objective To identify the prevalence of cutaneous toxicity in patients with melanoma treated with immune checkpoint inhibitors as monotherapy and/or in combination with chemotherapy and/or radiotherapy. Materials and methods We performed a systematic review and meta-analysis, which encompassed both clinical trials and observational studies describing the dermatological toxicities in patients treated with immune checkpoint inhibitors. The protocol was registered in the International Prospective Register of Systematic Review under the number CRD42018091915. The searches were performed using the CINAHL, Cochrane CENTRAL, LILACS, LIVIVO, PubMed, Scopus, and Web of Science databases. The methodological quality of the studies was evaluated with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data Results A total of 9,802 articles were identified in the databases. The final sample comprised 39 studies. The evaluated drugs were ipilimumab, tremelimumab, pembrolizumab, and nivolumab. The results suggest that the most prevalent side effect was grade 1 and 2 pruritus (24%), followed by grade 1 and 2 rash (21%) and grade 1 and 2 vitiligo (10%). Conclusion The most prevalent side effects in patients treated with checkpoint inhibitors are pruritus, rash, and vitiligo, and they are rated mostly as grades 1 and 2 adverse events. Remarkably, vitiligo is most commonly found in patients treated with PD-1 inhibitors.

The delicate relation between melanocytes and skin immunity: A game of hide and seek

“…Melanoma‐associated depigmentation is linked with a better prognosis (Dousset et al, 2021). Anti‐CTLA‐4 and especially anti‐PD‐1 therapy have been associated with vitiligo‐like depigmentation in around 10% of patients (Mineiro Dos Santos Garrett et al, 2021). Some reports state that pronounced confetti‐like depigmentation and older age of onset might suggest melanoma‐associated depigmentations.…”

Kutane Nebenwirkungen unter Immun-Checkpoint-Inhibitor-Therapie

“…Juckreiz stellt eine der häufigsten cuAE unter Immun-Checkpoint-Inhibition (ICI) dar 1 - sowohl als Pruritus auf blander Haut als auch als begleitendes Symptom weiterer cuAE. Er betrifft etwa ein Viertel der behandelten Patienten unabhängig von der Tumorentität 5 . Insbesondere unter der Therapie mit Ipilimumab als Kombinations- oder Monotherapie tritt Juckreiz sehr häufig auf 5 .…”

“…Er betrifft etwa ein Viertel der behandelten Patienten unabhängig von der Tumorentität 5 . Insbesondere unter der Therapie mit Ipilimumab als Kombinations- oder Monotherapie tritt Juckreiz sehr häufig auf 5 .…”

“…In Fallberichten war auch Aprepitant wirksam 6 . Juckreiz kann aber auch anderen cuAE wie Exanthemen oder – seltener – blasenbildenden Dermatosen vorausgehen, weshalb regelmäßige Verlaufsbeobachtungen sinnvoll sind 5 .…”

Knowledge, Attitude and Practice for Pruritus Management in Physicians and Patients with Diabetes

“…The main comorbidities in pruritis including diabetes are synthesized using the Charlson comorbidity index [ 13 , 14 ]. Additionally, pruritis was determined to be the most frequent dermatological condition in lung cancer and melanoma patients using immune checkpoint inhibitors ranging from grade 1–4 depending on the therapy used [ 15 , 16 ].…”