Immune checkpoint inhibitor-induced subacute cutaneous lupus erythematosus: a case report and review of the literature

Frontiers in Medicine, Journal Year: 2024, Volume and Issue: 11

Published: Feb. 1, 2024

Immune checkpoint inhibitor (ICI) use has been associated with numerous autoimmune side effects, known as immune related adverse events (irAEs). Cutaneous irAEs are common and affect up to 50% of patients treated ICIs. There have an increasing number cases reported in the literature regarding ICI-induced subacute cutaneous lupus erythematosus (SCLE). SCLE is important recognize it can result a delayed and/or prolonged skin reaction despite treatment discontinuation. We describe patient gastro-esophageal adenocarcinoma who developed following one cycle nivolumab treatment. A 75-year-old man presented our clinic new photo-distributed rash composed oval scaly pink papules plaques involving his chest arms. Despite topical corticosteroids, he emergency department 1 week later worsening rash. Skin biopsy showed vacuolar interface pattern, along superficial perivascular lymphocytic infiltrate, consistent drug eruption. The clinicopathological presentation was SCLE. Nivolumab discontinued due severity remitted systemic high potency steroids, hydroxychloroquine. Unfortunately, intraperitoneal metastatic disease, enrolled hospice care. In this paper, we highlight importance early identification irAE. review literature, including discussion on management also provided.

Language: Английский

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Expert Perspective: Immune Checkpoint Inhibitors and Rheumatologic Complications

Arthritis & Rheumatology, Journal Year: 2020, Volume and Issue: 73(4), P. 553 - 565

Published: Nov. 13, 2020

Rheumatologists increasingly receive consults for patients treated with immune checkpoint inhibitors (ICIs) cancer. ICIs can cause inflammatory syndromes known as immune‐related adverse events (IRAEs). Several rheumatic IRAEs have been reported, including arthritis, polymyalgia rheumatica, and myositis. For who present musculoskeletal symptoms while receiving ICI therapy, it is important to an algorithm evaluation. The differential diagnosis includes a range of syndromes, such crystalline mechanical issues, osteoarthritis, in addition IRAEs. After diagnosing IRAE, rheumatologists must work the patient oncologist form treatment plan. Treatment guided by severity. Evidence management limited observational studies. Inflammatory arthritis rheumatica are nonsteroidal antiinflammatory drugs mild cases, glucocorticoids moderate‐to‐severe sometimes require other disease‐modifying antirheumatic drugs. Myositis due be accompanied myocarditis or myasthenia gravis. Glucocorticoids withholding usually required treat myositis; some severe myositis intravenous immunoglobulin plasmapheresis. Further research needed optimize that does not compromise antitumor effect ICIs.

Language: Английский

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Cutaneous lupus erythematosus induced by drugs - novel insights

Expert Review of Clinical Pharmacology, Journal Year: 2019, Volume and Issue: 13(1), P. 35 - 42

Published: Nov. 27, 2019

Introduction: There is a growing list of drugs implicated in inducing both subacute and chronic forms cutaneous lupus erythematosus. It important to recognize these order quickly treat patients with drug induced disease.Areas covered: This paper reviews the current literature describing causing A Pubmed search was used compile medications up August 2019. new classes identified as erythematosus, pathophysiology disease process, recommendations for treatment disease.Expert opinion: Many have been lupus, many more continue be described reports. Further research needed understand this phenomenon, which will aid diagnosis affected patients.

Language: Английский

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Immune Checkpoint Inhibitors and Lupus Erythematosus

Pharmaceuticals, Journal Year: 2024, Volume and Issue: 17(2), P. 252 - 252

Published: Feb. 15, 2024

Immune checkpoint inhibitors (ICIs) are the standard of care for a growing number malignancies. Unfortunately, they associated with broad range unique toxicities that mimic presentations primary autoimmune conditions. These adverse events termed immune-related (irAEs), which ICI-lupus erythematosus (ICI-LE) constitutes small percentage. Our review aims to describe available literature on ICI-LE and ICI treatment patients pre-existing lupus. Most diagnoses had findings only cutaneous lupus; four systemic lupus manifestations. Over 90% (27 29) cases received anti-PD-1/PDL-1 monotherapy, 1 combination therapy, anti-CTLA-4 treatment. About three-fourths (22 29 or 76%) were managed topical steroids, 13 (45%) hydroxychloroquine, 10 (34%) required oral corticosteroids. In our case series, none receiving therapy cancer flare their lupus, but few de novo irAE manifestations, all characterized as low-grade. The yielded seven flares from total 27 who ICI. manageable without need cessation.

Language: Английский

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Cutaneous drug-induced lupus erythematosus: Clinical and immunological characteristics and update on new associated drugs

Annales de Dermatologie et de Vénéréologie, Journal Year: 2021, Volume and Issue: 148(4), P. 211 - 220

Published: Oct. 26, 2021

Language: Английский

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De novo subacute cutaneous lupus erythematosus‐like eruptions in the setting of programmed death‐1 or programmed death ligand‐1 inhibitor therapy: clinicopathological correlation

Clinical and Experimental Dermatology, Journal Year: 2020, Volume and Issue: 46(2), P. 328 - 337

Published: Sept. 17, 2020

Immune checkpoint inhibitors (ICI) may cause eruptions resembling cutaneous autoimmune diseases. There are six cases of immunotherapy-associated subacute lupus erythematosus (SCLE) in the literature. We present details five patients referred to Skin Toxicity Program at Dana-Farber Cancer Institute/Brigham and Women's Center who developed de novo SCLE-like eruptions, along with clinicopathological correlation highlight potential mechanistic features important diagnostic points. Two were maintained on topical corticosteroids, antihistamines photoprotection. One had complete clearance two improvement addition hydroxychloroquine. Four continued their immunotherapy uninterrupted, while one suspended for a month before restarting full dose. Histopathologically, this series illustrates temporal evolution ICI-induced immune reactions SCLE subtype. Looking beyond universally lichenoid infiltrate, evolving evident. hypothesize that programmed death-1 blockade induce immunological recognition previously immunologically tolerated drug antigens, leading epitope spreading phenotype.

Language: Английский

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What’s the Price? Toxicities of Targeted Therapies in Breast Cancer Care

American Society of Clinical Oncology Educational Book, Journal Year: 2020, Volume and Issue: 40, P. 55 - 70

Published: May 1, 2020

Agents with mechanisms novel to breast cancer care have been approved treat cancer. These agents include drugs that target cyclin-dependent kinases, phosphoinositide 3-kinase PI3KCA gene mutations, PARP, checkpoint regulation, and antibody-drug conjugates. However, these approaches bring a risk of toxicities quite different from those conventional cytotoxic chemotherapy. Here, we review discuss related adverse events, particular attention endocrine, pulmonary, dermatologic toxicities. Endocrine associated therapies for are distinct often present symptoms the specific hormonal deficiencies rarely excess. Given complex sometimes irreversible nature toxicities, once recognized, transdisciplinary management an endocrinologist experienced managing drug-related is encouraged. Drug-related pneumonitis serious concern new targeted therapies. Presentation may not be easily distinguished, multidisciplinary team approach can optimize patient care. Heightened awareness crucial early detection treatment. Management should follow recommendations provided by National Cancer Institute Common Terminology Criteria Adverse Events agent-specific guidelines. Cutaneous anticancer represent common poorly characterized challenge patients Although our understanding effects continues improve, breadth spans all conditions. Targeted offer effective therapeutic strategies but also event profiles. In this era, it will important both closely monitoring remain vigilant emerging

Language: Английский

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Cutaneous adverse events of immune checkpoint inhibitor therapy: incidence and types of reactive dermatoses

Journal of Dermatological Treatment, Journal Year: 2021, Volume and Issue: 33(3), P. 1691 - 1695

Published: March 3, 2021

Background Dermatoses are common and potentially serious complications of programmed cell death receptor PD-1 immune checkpoint inhibitor (anti-PD-1 ICI) therapy. Understanding their incidence is necessary to support clinical awareness, diagnosis, management.Objective To examine the odds reported non-cancerous dermatoses in setting anti-PD-1 ICI therapy.Methods Cross-sectional study (pembrolizumab or nivolumab) treated patients at a tertiary healthcare institution. Selected dermatologic events following immunotherapy were identified electronic medical record. Comparator arm that developed these same without receiving therapy.Results There 13.7% (254/1857) one 28 dermatoses. Compared with general population, had greater risk for development mucositis (OR 65.7, 95% CI 35.0–123.3), xerostomia 11.9, 8.4–16.8), pruritus (11.3, 8.9–14.3), lichen planus/lichenoid dermatitis 10.7, 5.6–20.7).Conclusions We report frequency encountered therapy, both (pruritus, rash, vitiligo) uncommon (scleroderma, urticaria).

Language: Английский

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Pyodermitis during Nivolumab Treatment for Non-Small Cell Lung Cancer: A Case Report and Review of the Literature

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(5), P. 4580 - 4580

Published: Feb. 26, 2023

Immunotherapy in oncology is replacing traditional therapies due to it specific action and limited side effects. Despite the high efficacy of immunotherapy, effects such as bacterial infection have been reported. Bacterial skin soft tissue infections represent one most important differential diagnoses patients presenting with reddened swollen tissue. Among these infections, cellulitis (phlegmon) abscesses are frequent. In cases, occur locally possible contiguous spread, or a multifocal manifestation, especially immunocompromised patients. Herein, we report case pyodermitis an district patient treated nivolumab for non-small cell lung cancer. A 64-year-old, smoker male showed cutaneous lesions at different evolution level left arm, all tattooed area, phlegmon two ulcerated lesions. Microbiological cultures gram staining revealed caused by methicillin-susceptible but erythromycin-resistant (ER-R), clindamycin-resistant (CL-R), gentamicin-resistant (GE-R) Staphylococcus aureus strain. immunotherapy becoming milestone oncologic treatment, more than spectrum immune-mediated toxicities agents needs be investigated. This highlights importance considering lifestyle background before starting cancer emphasis on pharmacogenomics possibility modified microbiota predisposing PD-1 inhibitors.

Language: Английский

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Manifestation of subacute cutaneous lupus erythematosus during treatment with anti-PD-1 antibody cemiplimab – a case report

Frontiers in Immunology, Journal Year: 2023, Volume and Issue: 14

Published: Dec. 8, 2023

The anti-programmed cell death protein 1 (PD-1) antibody cemiplimab has shown promising results in the treatment of unresectable or metastatic squamous carcinoma, however, frequently leads to immune-related adverse events limiting therapy efficacy. Although cutaneous side effects are common, only very few cases lupus erythematosus have been reported under anti-PD-1 immunotherapy. So far, no case described with cemiplimab. For first time, we report a patient advanced who developed clinical and histological findings sun-exposed skin that were consistent anti-SS-A/Ro antibody-positive subacute (SCLE) Additionally, laboratory chemical analyses revealed severe hepatitis without symptoms. Both, SCLE hepatitis, resolved after administration topical systemic steroids discontinuation therapy. Treatment can be associated appearance areas. Application glucocorticoids lead rapid resolution eruptions. Moreover, our illustrates possibility simultaneously occurring events. This highlights importance additional diagnostics avoid overlooking

Language: Английский

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