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Pembrolizumab Cutaneous Adverse Events and Their Association With Disease Progression
Martina Sanlorenzo1, Igor Vujic1, Adil Daud1
1Mt Zion Cancer Research Center, Department of Dermatology, University of California-San Francisco (Sanlorenzo, Vujic, Daud, Algazi, Gubens, Luna, Lin, Ortiz-Urda); Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy (Sanlorenzo, Quaglino); Department of Dermatology, The Rudolfstiftung Hospital, Academic Teaching Hospital, Medical University Vienna, Vienna, Austria (Vujic, Rappersberger).
Importance:
Immunomodulatory anticancer drugs, such as the anti-programmed death-1 drug pembrolizumab, have shown promising results in trials, and more patients will receive such treatments. Little is known about cutaneous adverse events (AEs) caused by these drugs and their possible correlation with treatment response.
Objective:
To describe the frequency and spectrum of cutaneous AEs linked with pembrolizumab and their possible correlation with treatment response.
Design, Setting, And Participants:
A single-institution, retrospective medical record review was conducted of patients with cancer who were treated with pembrolizumab from March 1, 2011, to May 28, 2014. The review comprised 83 consecutive patients who were enrolled in 2 clinical trials, received at least 1 dose of pembrolizumab, and had at least 1 follow-up visit. Patients were grouped according to the following therapeutic regimen for pembrolizumab: 43 received 10 mg/kg every 3 weeks, 24 received 10 mg/kg every 2 weeks, and 16 received 2 mg/kg every 3 weeks. Sixty-six patients were treated for melanoma, 15 patients for lung cancer, 1 patient for prostate cancer, and 1 patient for Merkel cell carcinoma. Median follow-up was 15 weeks (range, 2-105 weeks). The analysis was conducted from March 1 to September 30, 2014.
Main Outcomes And Measures:
Occurrence, severity, and type of cutaneous AEs, as well as disease progression and response to pembrolizumab treatment.
Results:
Thirty-five patients (42%) developed cutaneous AEs attributed to pembrolizumab. The most common cutaneous AEs were macular papular eruption (24 [29%]), pruritus (10 [12%]), and hypopigmentation (7 [8%]). All 7 patients who developed hypopigmentation were treated for melanoma. Survival analyses showed that patients who developed cutaneous AEs had significantly longer progression-free intervals in all 3 groups (pembrolizumab, 10 mg/kg, every 3 weeks, P = .001; pembrolizumab, 10 mg/kg, every 2 weeks, P = .003; pembrolizumab, 2 mg/kg, every 3 weeks, P = .009) compared with patients who did not develop cutaneous AEs.
Conclusions And Relevance:
Pembrolizumab therapy was associated with cutaneous AEs in 42% of patients. The development of cutaneous AEs, especially of hypopigmentation in patients with melanoma, could point toward better treatment response.
Insights
Pembrolizumab (anti-PD-1) therapy caused skin side effects in 42% of patients. Developing these adverse events, particularly hypopigmentation in melanoma patients, may indicate a better response to cancer treatment.
Area of Science:
- Oncology
- Immunology
- Dermatology
Background:
- Immunomodulatory anticancer drugs, including anti-programmed death-1 (PD-1) therapies like pembrolizumab, are increasingly used.
- Limited data exists on the dermatological adverse events (AEs) associated with these treatments and their impact on treatment efficacy.
Purpose of the Study:
- To determine the frequency and types of cutaneous AEs linked to pembrolizumab.
- To explore the correlation between these AEs and patient response to pembrolizumab therapy.
Main Methods:
- Retrospective review of 83 cancer patients treated with pembrolizumab across different regimens and diagnoses (melanoma, lung, prostate, Merkel cell carcinoma).
- Data collected on occurrence, severity, and type of cutaneous AEs, alongside disease progression and treatment response.
- Median follow-up was 15 weeks.
Main Results:
- 42% of patients experienced pembrolizumab-related cutaneous AEs.
- Most common AEs included macular papular eruption (29%), pruritus (12%), and hypopigmentation (8%).
- Patients who developed cutaneous AEs showed significantly longer progression-free survival across all pembrolizumab dosing groups.
Conclusions:
- Pembrolizumab is associated with cutaneous AEs in a significant portion of patients.
- The emergence of AEs, particularly hypopigmentation in melanoma patients, may serve as a predictive biomarker for enhanced treatment response.
- Further investigation into the relationship between AEs and treatment outcomes is warranted.
