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Patients receiving programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) antibodies exhibited papular and nodular eruptions with scale, as well as mucosal lesions with lichenoid features, that were typically manageable with topical steroid treatment, a study published in JAMA Dermatology has shown.1
PD-1 inhibitors, such as nivolumab and pembrolizumab, and anti-PD-L1 antibodies such as atezolizumab have demonstrated substantial activity in multiple malignancies, including advanced melanoma, non-small cell lung cancer, bladder cancer, renal cell carcinoma, and classical Hodgkin lymphoma. Despite their remarkable efficacy, these agents are associated with unique immune-related toxicity profiles.
Therefore, researchers sought to better characterize the clinical and histologic features of the lichenoid mucocutaneous adverse events observed in patients receiving PD-1 or PD-L1 inhibitor therapy.
For the study, investigators retrospectively analyzed data from 13 men and 7 women with advanced cancer who were referred to dermatology at Yale-New Haven Hospital after developing cutaneous adverse events while receiving single-agent anti-PD-1 or anti-PD-L1 therapy or in combination with another agent.
Results showed that 80% of the 20 patients had a clinical morphology consisting of erythematous papules with scale in a variety of distributions. For the 17 patients with available biopsy specimens, 94% exhibited features of lichenoid interface dermatitis.
A total of 18 patients received topical corticosteroids to treat the cutaneous reactions, with discontinuation of immunotherapy required in only 1 patient. Of note, only 20% of all patients developed peripheral eosinophilia.
However, 80% of patients were concomitantly taking medications that have been previously reported to induce lichenoid drug eruptions, suggesting that concurrent medications may play a role in the development of this skin reaction.
Reference
1. Shi VJ, Rodic N, Gettinger S, et al. Clinical and histologic features of lichenoid mucocutaneous eruptions due to anti–programmed cell death 1 and anti–programmed cell death ligand 1 immunotherapy. JAMA Dermatol. 2016 Jul 13. doi: 10.1001/jamadermatol.2016.2226. [Epub ahead of print]
