Subacute cutaneous lupus erythematosus induced by PD‐1 Inhibitor therapy: two case reports and literature review

Diago, A.; Hueso, L.; Ara‐Martín, Mariano; Abadías‐Granado, Isabel

doi:10.1111/ajd.13538

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…For instance, Marano et al described a patient with SCLC who developed dermatomyositis upon ICI rechallenge ( 44 ). Diago et al described a patient with NSCLC who developed hepatitis and pneumonitis following ICI rechallenge ( 7 ). This is important, as clinicians must navigate the balance between treatment of a patient’s malignancy, and the toxicities inherent with ICI treatment ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous irAEs are the most frequently reported irAEs, affecting 30%-50% of patients treated with ICIs, and have been associated with improved anti-tumor efficacy (4)(5)(6). There have been an increasing number of cases reported in the literature regarding ICI-induced subacute cutaneous lupus erythematosus (SCLE) (7)(8)(9)(10). While drug-induced SCLE typically resolves following discontinuation of the offending medication, ICI-induced SCLE is a distinct entity, which can result in a delayed and/or prolonged skin reaction despite treatment discontinuation (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Immune checkpoint inhibitor-induced subacute cutaneous lupus erythematosus: a case report and review of the literature

Khorasanchi,

Korman,

Manne

et al. 2024

Front. Med.

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Immune checkpoint inhibitor (ICI) use has been associated with numerous autoimmune side effects, known as immune related adverse events (irAEs). Cutaneous irAEs are common and affect up to 50% of patients treated with ICIs. There have been an increasing number of cases reported in the literature regarding ICI-induced subacute cutaneous lupus erythematosus (SCLE). ICI-induced SCLE is important to recognize as it can result in a delayed and/or prolonged skin reaction despite treatment discontinuation. We describe a patient with gastro-esophageal adenocarcinoma who developed SCLE following one cycle of nivolumab treatment. A 75-year-old man presented to our clinic with a new photo-distributed rash composed of oval scaly pink papules and plaques involving his chest and arms. Despite treatment with topical corticosteroids, he presented to the emergency department 1 week later with worsening rash. Skin biopsy showed vacuolar interface pattern, along with superficial perivascular lymphocytic infiltrate, consistent with a drug eruption. The clinicopathological presentation was consistent with ICI-induced SCLE. Nivolumab treatment was discontinued due to the severity of the rash. The rash remitted with systemic corticosteroids, high potency topical steroids, and hydroxychloroquine. Unfortunately, the patient developed intraperitoneal metastatic disease, and was enrolled in hospice care. In this paper, we highlight the importance of early identification and treatment of this irAE. A review of the literature, including a discussion on the management of ICI-induced SCLE is also provided.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor-induced subacute cutaneous lupus erythematosus: a case report and review of the literature

Khorasanchi,

Korman,

Manne

et al. 2024

Front. Med.

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“…In patients treated with the anti-PD-1 antibodies pembrolizumab or nivolumab moderate SCLE eruptions could be treated successfully by discontinuation of immunotherapy and were kept under control after re-initiation of systemic treatment by the use of topical steroids (16,17). In addition to treatment discontinuation and topical steroids the use of systemic hydroxychloroquine and/or glucocorticoids alone or in combination was described to resolve severe SCLE skin eruptions (10-12, [18][19][20][21][22][23]. By this means, immunotherapy could be continued successfully in some cases without or with only a mild relapse of SCLE (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Manifestation of subacute cutaneous lupus erythematosus during treatment with anti-PD-1 antibody cemiplimab – a case report

Fietz,

Fröhlich,

Mauch

et al. 2023

Front. Immunol.

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IntroductionThe anti-programmed cell death protein 1 (PD-1) antibody cemiplimab has shown promising results in the treatment of unresectable or metastatic squamous cell carcinoma, however, frequently leads to immune-related adverse events limiting therapy efficacy. Although cutaneous side effects are common, only very few cases of cutaneous lupus erythematosus have been reported under anti-PD-1 immunotherapy. So far, no case of cutaneous lupus has been described under treatment with cemiplimab.Case reportFor the first time, we report the case of a patient with advanced squamous cell carcinoma, who developed clinical and histological findings in sun-exposed skin that were consistent with anti-SS-A/Ro antibody-positive subacute cutaneous lupus erythematosus (SCLE) under treatment with cemiplimab. Additionally, laboratory chemical analyses revealed a severe immune-related hepatitis without clinical symptoms. Both, the SCLE and the hepatitis, resolved after the administration of topical and systemic steroids and the discontinuation of anti-PD-1 therapy.ConclusionTreatment with cemiplimab can be associated with the appearance of cutaneous lupus erythematosus in sun-exposed areas. Application of topical and systemic glucocorticoids can lead to a rapid resolution of the skin eruptions. Moreover, our case illustrates the possibility of simultaneously occurring severe immune-related adverse events. This highlights the importance of additional diagnostics to avoid overlooking additional immune-related adverse events.

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“…The majority of the literature available is confined to case reports and small case series, the preponderance of which describes CLE. Details on these patients are found in Table 1 [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. Patients rarely met criteria for SLE [ 55 ].…”

Section: Immune Checkpoint Inhibitor-associated Lupus Erythematosusmentioning

confidence: 99%

Immune Checkpoint Inhibitors and Lupus Erythematosus

Vitzthum von Eckstaedt,

Singh,

Reid

et al. 2024

Pharmaceuticals

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Immune checkpoint inhibitors (ICIs) are the standard of care for a growing number of malignancies. Unfortunately, they are associated with a broad range of unique toxicities that mimic the presentations of primary autoimmune conditions. These adverse events are termed immune-related adverse events (irAEs), of which ICI-lupus erythematosus (ICI-LE) constitutes a small percentage. Our review aims to describe the available literature on ICI-LE and ICI treatment for patients with pre-existing lupus. Most diagnoses of ICI-LE had findings of only cutaneous lupus; four diagnoses of ICI-LE had systemic lupus manifestations. Over 90% (27 of 29) of cases received anti-PD-1/PDL-1 monotherapy, 1 received combination therapy, and 1 received only anti-CTLA-4 treatment. About three-fourths (22 of 29 or 76%) of patients with ICI-lupus were managed with topical steroids, 13 (45%) received hydroxychloroquine, and 10 (34%) required oral corticosteroids. In our case series, none of the patients with pre-existing lupus receiving ICI therapy for cancer had a flare of their lupus, but few had de novo irAE manifestations, all of which were characterized as low-grade. The review of the literature yielded seven ICI-LE flares from a total of 27 patients with pre-existing lupus who received ICI. Most flares were manageable without need for ICI cessation.

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Subacute cutaneous lupus erythematosus induced by PD‐1 Inhibitor therapy: two case reports and literature review

Cited by 8 publications

References 9 publications

Immune checkpoint inhibitor-induced subacute cutaneous lupus erythematosus: a case report and review of the literature

Immune checkpoint inhibitor-induced subacute cutaneous lupus erythematosus: a case report and review of the literature

Manifestation of subacute cutaneous lupus erythematosus during treatment with anti-PD-1 antibody cemiplimab – a case report

Immune Checkpoint Inhibitors and Lupus Erythematosus

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