Striking enhancement at the site of radiation for nivolumab-induced Stevens-Johnson syndrome

Shah, Kishan M.; Rancour, Elizabeth A.; Al‐Omari, Ahmed; Rahnama‐Moghadam, Sahand

doi:10.5070/d3246040713

Cited by 16 publications

(12 citation statements)

References 6 publications

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“…Seven cases were SJS, while TEN was diagnosed in three cases [12,13,15], and one case was an SJS/TEN overlap in keeping with our reported patient [17]. SJS/TEN rash onset ranged from 1 week [16,20] to 4 months [14] with an average latency of 2 -4 weeks. Interestingly, in the latter case [14], SJS rash appeared after eight cycles of nivolumab therapy in a similar pattern of delayed autoimmune diseases [14].…”

Section: Discussionsupporting

confidence: 79%

“…Recall radiation dermatitis in association with SJS/TEN observed in the presented patient was described in similar two cases that were pre-medicated with radiotherapy [ 20 , 21 ], and this phenomenon of the distinct distribution of rash over previous radiation sites may be related to a selective re-exposure of certain epitopes from radiation-damaged skin cells to locally hyperactive T cells [ 20 ].…”

Section: Discussionmentioning

confidence: 76%

“…An extensive review published by Maloney et al [4] identified a total of 18 patients with SJS/TEN following treatment with different anti-PD-1 agents (pembrolizumab, ipilimumab, nivolumab, and atezolizumab) [4]. We conducted a comprehensive search to identify nivolumab-induced SJS and/or TEN cases (either as a mono- therapy or combination therapy), which yielded 11 patients [12][13][14][15][16][17][18][19][20][21][22]. One patient was managed with dual therapy with ipilimumab, and one was treated with nivolumab after the failure of ipilimumab.…”

Section: Discussionmentioning

confidence: 99%

“…No trials of nivolumab rechallenge after SJS/TEN diagnosis were attempted in the available literature [4]. Immunosuppressive therapy with systemic steroids was associated with better outcomes of SJS, as all the seven cases of nivolumab-induced SJS (without TEN) had survived [14,16,[18][19][20][21][22]. Furthermore, a recent meta-analysis has reported a beneficial role for cyclosporin (CsA) in SJS/TEN management, as CsA may block the cytotoxic T cells-induced epithelial cell injury [26].…”

Section: Discussionmentioning

confidence: 99%

“…SJS/TEN rash onset ranged from 1 week [ 16 , 20 ] to 4 months [ 14 ] with an average latency of 2 - 4 weeks. Interestingly, in the latter case [ 14 ], SJS rash appeared after eight cycles of nivolumab therapy in a similar pattern of delayed autoimmune diseases [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma

et al. 2022

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Nivolumab is a humanized monoclonal anti-programmed cell death receptor-1 (PD-1) antibody that has been authorized for use in the treatment of advanced malignancies. Cutaneous reactions are the most common immune-related adverse events reported with anti-PD-1 agents, and they range broadly from mild localized reactions to rarely severe or life-threatening systemic dermatoses. The occurrence of Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with nivolumab use is an exceedingly rare phenomenon that was only documented in a handful of cases in the current literature, but it deserves careful attention as SJS/TEN may be associated with fatal outcomes. We present a case of nivolumab-induced SJS/TEN in a middle-aged female patient with metastatic gastric adenocarcinoma that was successfully treated with immunosuppressive therapy and supportive care. Prompt recognition of SJS/TEN with discontinuation of nivolumab is warranted when SJS/TEN is suspected clinically. Multidisciplinary management in a specialized burn unit is the key to improving outcomes of SJS/TEN.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma

et al. 2022

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

2022

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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.

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Immune checkpoint inhibitor associated epidermal necrosis, beyond SJS and TEN: a review of 98 cases

Bray,

Lin,

et al. 2024

Arch Dermatol Res

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Striking enhancement at the site of radiation for nivolumab-induced Stevens-Johnson syndrome

Cited by 16 publications

References 6 publications

Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma

Steven-Johnson Syndrome: A Rare but Serious Adverse Event of Nivolumab Use in a Patient With Metastatic Gastric Adenocarcinoma

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

Immune checkpoint inhibitor associated epidermal necrosis, beyond SJS and TEN: a review of 98 cases

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