Systemic treatment of immune checkpoint inhibitor-induced psoriasis: Inference-based guidance

Area of Science:

• Oncology
• Dermatology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) are vital cancer treatments but can cause psoriasis.
• Managing ICI-induced psoriasis with systemic agents (saPs) raises concerns about reduced ICI effectiveness.
• Limited direct evidence exists for managing ICI-mediated psoriasis (ICI-Ps).

Purpose of the Study:

• To address clinical questions on managing ICI-Ps with saPs.
• To evaluate the impact of saPs on ICI efficacy.
• To provide a framework for healthcare professionals and patients.

Main Methods:

• A Delphi process involving 15 international specialists in dermatology, oncology, immunology, and rheumatology.
• Systematic literature review combined with an inference-based methodology.
• Evaluation of various saPs, including biologics, traditional systemic therapies, small molecules, retinoids, and corticosteroids.

Main Results:

• Inference-based conclusions were drafted on the use of saPs for ICI-Ps.
• The potential impact of saPs on ICI efficacy was a primary focus.
• A structured framework was developed to guide discussions on saP risks and benefits.

Conclusions:

• Systemic agents for psoriasis (saPs) can be used for ICI-Ps without significant loss of ICI effectiveness.
• Interrupting ICI therapy is generally not necessary for managing ICI-Ps.
• Non-steroid saPs are preferred over systemic corticosteroids when available.