[Dermatologic toxicities of immune checkpoint inhibitors]

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 or CTLA-4 have revolutionized cancer therapy.
• Their mechanism involves T-cell activation, leading to a unique profile of immune-related adverse events (irAEs).
• Dermatologic toxicities are the most frequent irAEs associated with ICIs.

Purpose of the Study:

• To review the incidence and spectrum of dermatologic adverse events caused by ICIs.
• To provide a management algorithm for managing these skin toxicities.
• To emphasize the importance of dermatological evaluation for ICI-treated patients.

Main Methods:

• Review of reported dermatologic adverse events in patients treated with immune checkpoint inhibitors.
• Analysis of the incidence, clinical presentation, and management strategies for cutaneous irAEs.
• Development of a proposed management algorithm for dermatologic toxicities.

Main Results:

• Cutaneous adverse events affect over a third of patients, commonly presenting as maculopapular rash, pruritus, or vitiligo (melanoma patients).
• Less common but specific dermatologic disorders include lichenoid reactions, psoriasis, sarcoidosis, autoimmune diseases, and acneiform eruptions.
• Most skin toxicities are mild to moderate and do not necessitate treatment discontinuation, but rigorous evaluation is needed for severe or atypical cases.

Conclusions:

• Dermatologic adverse events are common with immune checkpoint inhibitors but generally manageable.
• Prompt and thorough dermatological assessment is crucial for effective management and continued cancer therapy.
• A structured approach to managing skin toxicities can optimize patient outcomes and treatment adherence.