Extracorporeal photopheresis for pembrolizumab-induced dermatitis: a case report

Immune-related adverse events (irAE) are common in checkpoint blockade-treated patients and limit its clinical application. Corticosteroids are the first-line therapy for treatment of irAE, but animal models clearly demonstrate that steroids diminish anti-programmed cell death protein 1 (PD-1)-induced tumour immunity. Better strategies to manage irAE while preserving anti-tumour immunity are needed. Extracorporeal photopheresis (ECP) was recently introduced as second-line treatment for steroid-refractory immune checkpoint inhibitor (ICI)-related colitis and hepatitis. Here, we extend the application of ECP to immune-related maculopapular rash after adjuvant anti-PD-1 therapy in a single melanoma patient. The patient's dermatitis markedly improved after off-label ECP, with a substantial reduction in skin lesions and pruritus scores, and stabilization of immune markers. The patient remained well after ECP with no recurrent or metastatic disease at 14 months after starting ECP treatment. Hence, in this case, ECP led to successful resolution of pembrolizumab-induced dermatitis and a favourable oncological outcome.