Biologic therapies for checkpoint inhibitor-induced cutaneous toxicities: a single-institution study of 17 consecutively treated patients
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Published on: February 5, 2020
Jonathan J Lo1, Meghan M Heberton2, Omar Pacha2
1Baylor College of Medicine, Houston, TX, USA.
Purpose:
Treatment options for corticosteroid-refractory and/or high-grade checkpoint inhibitor (CPI)-induced cutaneous adverse events (CAEs) are limited; however, anecdotal reports of biologic therapies have been successful. We aim to characterize the appropriate treatment scenarios and safety and efficacy profiles of biologics used to treat patients with CPI-induced CAEs at a single institution.
Methods:
This is a retrospective case series of patients from January 1st, 2015 to October 20th, 2020, with CPI-induced CAEs who were treated with biologics at a single cancer center. Patients were identified using institutional electronic medical record who underwent CPI therapy with subsequent CAEs that necessitated biologic therapy. Diagnostic criteria utilized for CAEs were based on documentation by four board-certified dermatologists, in combination with detailed chart reviews and pathology findings. Primary study outcome measurements include CAE response, tumor response, and adverse events during biologics treatment.
Results:
We identified 17 patients who fit study criteria. Sixteen patients experienced some degree of CAE improvement on biologics, with 10 of 10 patients reaching CAE resolution at 6 months post biologics. Eight patients needed new systemic treatment post biologics treatment, while 9 patients received no further treatment or stayed on the CPI. Thirteen patients tolerated biologics well with no significant adverse events or blood abnormalities, with only 2 patients experiencing biologic dose delays.
Conclusion:
In our cohort, biologics appear to be extremely efficacious in the treatment of severe-grade and/or steroid refractory CAEs. They also appeared to be well-tolerated without overtly negative effects on tumor response. In patients with limited cancer treatment options and good tumor response to CPIs, biologics should be considered for severe-grade and/or refractory CAEs.
Insights
Biologic therapies show high efficacy and good tolerability for treating severe cutaneous adverse events (CAEs) induced by checkpoint inhibitors (CPIs). These treatments offer a valuable option for patients with limited therapeutic choices and good tumor response to CPIs.
Area of Science:
- Dermatology
- Oncology
- Immunology
Background:
- Checkpoint inhibitor (CPI) therapy can cause severe cutaneous adverse events (CAEs).
- Treatment options for refractory or high-grade CAEs are limited.
- Biologic therapies have shown anecdotal success in managing these events.
Purpose of the Study:
- To characterize treatment scenarios for biologics in CPI-induced CAEs.
- To evaluate the safety and efficacy of biologic therapies for these CAEs.
- To assess biologic treatment outcomes at a single institution.
Main Methods:
- Retrospective case series of 17 patients treated with biologics for CPI-induced CAEs (2015-2020).
- CAEs diagnosed via dermatologist documentation, chart reviews, and pathology.
- Outcomes measured included CAE response, tumor response, and adverse events.
Main Results:
- Sixteen of 17 patients showed CAE improvement with biologics.
- 100% CAE resolution at 6 months in 10 patients.
- Biologics were well-tolerated; 13 patients had no significant adverse events.
Conclusions:
- Biologics are highly efficacious for severe/refractory CPI-induced CAEs.
- Biologics demonstrate good tolerability without negatively impacting tumor response.
- Consider biologics for severe CAEs in patients with limited treatment options and good CPI tumor response.
