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Published on: October 12, 2012
Pembrolizumab-Induced Acute Skin Reaction: A Case Report and Review of Literature
Mathew Thomas1, Ali Wazir2, Aarati Poudel3
1Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Abstract:
The development of immune checkpoint inhibitors is considered to be one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-ligand 1 (PD-L1) receptor that has demonstrated antineoplastic activity against various malignancies including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab has been associated with significant dermatological adverse reactions, referred to as immune-related adverse events. The cutaneous adverse effects can affect the quality of life of the patient and can result in dose reduction or even discontinuation of the treatment. Hence it is of utmost importance to have a comprehensive understanding of the cutaneous toxicities for prompt initiation of treatment. We present the case of a 49-year-old male with metastatic non-small cell lung cancer (NSCLC) with 100% PD-L1 expression, who suffered a severe cutaneous reaction involving more than 95% of body surface area, following the first dose of pembrolizumab. He was treated with low-dose systemic steroids (prednisone 10 mg), to which he responded well. Since the patient showed excellent symptomatic and clinical response to pembrolizumab, it was not discontinued. The patient has not developed a rash with subsequent doses of pembrolizumab, and the steroids were tapered off.
Insights
Pembrolizumab, an immune checkpoint inhibitor, can cause severe skin reactions in cancer patients. Early steroid treatment effectively managed a patient's extensive rash, allowing continued cancer therapy.
Area of Science:
- Oncology
- Dermatology
- Immunology
Background:
- Immune checkpoint inhibitors like pembrolizumab represent a significant advancement in cancer therapy.
- Pembrolizumab targets the programmed death-ligand 1 (PD-L1) receptor, showing efficacy in malignancies such as non-small cell lung cancer (NSCLC).
- Dermatological adverse events are common with pembrolizumab, impacting patient quality of life and treatment adherence.
Observation:
- A 49-year-old male with metastatic NSCLC experienced a severe cutaneous reaction (>95% body surface area) after his first pembrolizumab dose.
- The patient had 100% PD-L1 expression, indicating potential for pembrolizumab efficacy.
- The severe rash was managed with low-dose systemic steroids (prednisone 10 mg).
Findings:
- The patient demonstrated a positive response to low-dose prednisone.
- Pembrolizumab treatment was continued due to excellent anti-cancer response.
- Subsequent pembrolizumab doses did not trigger further rash development, and steroids were tapered.
Implications:
- Prompt recognition and management of pembrolizumab-induced cutaneous toxicities are crucial for maintaining cancer treatment.
- Low-dose systemic steroids can be effective in managing severe immune-related dermatological adverse events.
- Continued pembrolizumab therapy is feasible even after significant skin reactions with appropriate management.
