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Diverse cutaneous adverse eruptions caused by anti-programmed cell death-1 (PD-1) and anti-programmed cell death
John Shen1, Jason Chang2, Melody Mendenhall1
1Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Background:
The anti-programmed cell death-1 (PD-1) and anti-programmed cell death ligand-1 (PD-L1) immunotherapies have shown exceptional activity in many cancers. However, these immunotherapies can also result in diverse adverse cutaneous eruptions that need to be better characterized for ongoing management. The objective was to provide clinical and histopathologic descriptions of the variety of cutaneous adverse events seen in patients who received anti-PD-1/PD-L1 treatment and discuss their management.
Methods:
Patients with advanced cancers in clinical trials at University of California Los Angeles (UCLA), receiving anti-PD-1/PD-L1 treatment between 2012 and 2016 who developed cutaneous eruptions and were evaluated in the dermatology clinic were included in this retrospective case series study. A total of 16 patients were included in this study; of these, five were treated with pembrolizumab alone, two with avelumab alone, eight with nivolumab plus ipilimumab and one with nivolumab plus T-Vec. Of these 16 patients, eight had received systemic chemotherapy, six had received radiotherapy, and one had received trememlimumab prior to the immunotherapies described in this study.
Results:
Cutaneous eruptions occurred at variable times, from week 1 to 88, with a median of 11.5 weeks; the morphologies included lichenoid, bullous, psoriasiform, macular, morbiliform appearances, and alopecia which were confirmed histopathologically in several of the cases. All cutaneous immune-related adverse events were either grade 1 or 2. Ten patients were treated with topical corticosteroids, and one also received NBUVB. Four patients eventually required systemic steroids. Three required discontinuation of their anti-PD-1/PD-L1 therapy secondary to the cutaneous eruptions.
Conclusions:
There are several different types of adverse cutaneous morphologies that may be seen with administration of PD-1 and PD-L1 inhibitors. Identifying the patterns of eruption may assist in prompt treatment. Most eruptions could be managed with topical corticosteroids and without discontinuation of the systemic treatment.
Insights
Adverse cutaneous eruptions from anti-programmed cell death-1 (PD-1) and anti-programmed cell death ligand-1 (PD-L1) immunotherapies can manifest in various ways. Most skin reactions are manageable with topical corticosteroids, often without needing to stop cancer treatment.
Area of Science:
- Oncology
- Dermatology
- Immunotherapy
Background:
- Anti-programmed cell death-1 (PD-1) and anti-programmed cell death ligand-1 (PD-L1) immunotherapies are effective cancer treatments.
- These therapies can cause diverse adverse cutaneous eruptions, necessitating better characterization and management strategies.
Purpose of the Study:
- To describe the clinical and histopathologic features of cutaneous adverse events in patients receiving anti-PD-1/PD-L1 therapy.
- To discuss management approaches for these skin reactions.
Main Methods:
- Retrospective case series of 16 advanced cancer patients treated with anti-PD-1/PD-L1 agents at UCLA (2012-2016).
- Patients evaluated in dermatology clinic for cutaneous eruptions.
- Included various anti-PD-1/PD-L1 agents and prior treatments like chemotherapy and radiotherapy.
Main Results:
- Cutaneous eruptions appeared between weeks 1-88 (median 11.5 weeks) with varied morphologies (lichenoid, bullous, psoriasiform, etc.).
- All events were Grade 1 or 2; most treated with topical corticosteroids, some required systemic steroids.
- Three patients discontinued immunotherapy due to skin reactions.
Conclusions:
- Diverse cutaneous morphologies can occur with PD-1/PD-L1 inhibitors.
- Identifying eruption patterns aids prompt treatment.
- Most skin reactions are manageable with topical corticosteroids, often allowing continuation of immunotherapy.
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