Immune checkpoint inhibitor-related dermatologic adverse events

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:83

Review

Geisler, Amaris N.¹  Phillips, Gregory S.²  Barrios, Dulce M.¹  Wu, Jennifer³  Leung, Donald Y. M.⁴  Moy, Andrea P.⁵  Kern, Jeffrey A.⁴  Lacouture, Mario E.^1,6 

[1] Mem Sloan Kettering Canc Ctr, Dept Med, Dermatol Serv, 530 E 74th St, New York, NY 10021 USA

[2] SUNY Downstate Hlth Sci Univ, Brooklyn, NY USA

[3] Chang Gung Univ, Chang Gung Mem Hosp Linkou, Sch Med, Taoyuan, Taiwan

[4] Natl Jewish Hlth, Dept Pediat, Div Pediat Allergy & Immunol, Denver, CO USA

[5] Mem Sloan Kettering Canc, New York, NY USA

[6] Weill Cornell Med, New York, NY USA

关键词: checkpoint inhibitor;    CTLA-4 inhibitor;    dermatologic adverse event;    immune-related cutaneous adverse event;    lichenoid eruption;    maculopapular rash;    PD-1 inhibitor;    PD-L1 inhibitor;    pruritus;    vitiligo;   

DOI  :  10.1016/j.jaad.2020.03.132

来源: Elsevier

【 摘 要 】

Immune checkpoint inhibitors have emerged as a pillar in the management of advanced malignancies. However, nonspecific immune activation may lead to immune-related adverse events, wherein the skin and its appendages are the most frequent targets. Cutaneous immune-related adverse events include a diverse group of inflammatory reactions, with maculopapular rash, pruritus, psoriasiform and lichenoid eruptions being the most prevalent subtypes. Cutaneous immune-related adverse events occur early, with maculopapular rash presenting within the first 6 weeks after the initial immune checkpoint inhibitor dose. Management involves the use of topical corticosteroids for mild to moderate (grades 1-2) rash, addition of systemic corticosteroids for severe (grade 3) rash, and discontinuation of immunotherapy with grade 4 rash. Bullous pemphigoid eruptions, vitiligo-like skin hypopigmentation/depigmentation, and psoriasiform rash are more often attributed to programmed cell death-1/programmed cell death ligand-1 inhibitors. The treatment of bullous pemphigoid eruptions is similar to the treatment of maculopapular rash and lichenoid eruptions, with the addition of rituximab in grade 3-4 rash. Skin hypopigmentation/depigmentation does not require specific dermatologic treatment aside from photoprotective measures. In addition to topical corticosteroids, psoriasiform rash may be managed with vitamin D-3 analogues, narrowband ultraviolet B light phototherapy, retinoids, or immunomodulatory biologic agents. Stevens-Johnson syndrome and other severe cutaneous immune-related adverse events, although rare, have also been associated with checkpoint blockade and require inpatient care as well as urgent dermatology consultation.

【 授权许可】

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