Atezolizumab-induced scleroderma: a rare complication.

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Programmed death-ligand 1 (PD-L1) inhibitors are increasingly used for metastatic non-small cell lung cancer.
• Immune-related adverse events (irAEs) are known complications of PD-L1 inhibitors.
• Scleroderma is a rare irAE, with limited published data on its clinical features and management.

Observation:

• A female patient in her 60s developed skin thickening after initiating atezolizumab for non-small cell lung cancer.
• Histological examination confirmed scleroderma.
• The patient tested positive for the anti-PM/SCL-75 antibody.

Findings:

• Discontinuation of atezolizumab and initiation of mycophenolate mofetil led to mild improvement in skin thickening.
• The anti-PM/SCL-75 antibody may be associated with PD-L1 inhibitor-induced scleroderma.
• Early diagnosis of this rare complication is crucial.

Implications:

• This case highlights the importance of recognizing scleroderma as a potential irAE of PD-L1 inhibitors.
• Testing for scleroderma-associated autoantibodies, such as anti-PM/SCL-75, may facilitate earlier diagnosis.
• Prompt identification and management can potentially limit morbidity in patients with this rare condition.