Autoimmune dermatologic toxicities from immune checkpoint blockade with anti‐<scp>PD</scp>‐1 antibody therapy: a report on bullous skin eruptions

Jour, George; Glitza, Isabella C.; Ellis, Rachel M.; Torres‐Cabala, Carlos A.; Tetzlaff, Michael T.; Li, Janet Y.; Nagarajan, Priyadharsini; Huen, Auris; Aung, Phyu P.; Ivan, Doina; Drucker, Carol R.; Prieto, Víctor G.; Rapini, Ronald P.; Patel, Anisha B.; Curry, Jonathan L.

doi:10.1111/cup.12717

Cited by 128 publications

(126 citation statements)

References 14 publications

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“…Direct immunofluorescence studies in three of the four patients tested showed linear IgG and C3 immune deposits on the blister roof suggesting a diagnosis of bullous pemphigoid. These findings are not consistent with our report, as this patient had negative immunofluorescence on skin biopsy [4]. …”

Section: Discussioncontrasting

confidence: 99%

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Debilitating Skin Toxicity Associated with Pembrolizumab Therapy in an 81-Year-Old Female with Malignant Melanoma

Khokhar¹,

Kettle²,

Palla³

2016

Case Rep Oncol

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Frequently described immune-mediated adverse effects of immune therapy include dermatological complications, hepatitis, colitis, pneumonitis, and endocrinopathies. As utilization of pembrolizumab and related agents continues to expand both in the available indications as well as duration of exposure, there remains a significant potential to uncover previously undescribed adverse events. From a dermatological standpoint, 39% of patients receiving pembrolizumab therapy experience some form of skin-related drug toxicity [Naidoo et al.: Ann Oncol 2015;26: 2375–2391]. We describe a case of pembrolizumab-induced disabling autoimmune ectodermal toxicity.

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Section: Discussioncontrasting

confidence: 99%

“…Jour et al [4] described several cases of bullous skin eruptions associated with the anti-epidermal antibodies due to anti-PD-1 antibody therapy. The report consists of patients who presented with vesicles and blisters on the skin while being treated with anti-PD-1 antibody immunotherapy with either nivolumab or pembrolizumab.…”

Section: Discussionmentioning

confidence: 99%

Debilitating Skin Toxicity Associated with Pembrolizumab Therapy in an 81-Year-Old Female with Malignant Melanoma

Khokhar¹,

Kettle²,

Palla³

2016

Case Rep Oncol

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“…[10][11][12] One patient improved with rituximab, and one patient improved with omalizumab. [10][11][12] One patient improved with rituximab, and one patient improved with omalizumab.…”

Section: Methodsmentioning

confidence: 99%

A review of bullous pemphigoid associated with PD‐1 and PD‐L1 inhibitors

et al. 2018

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“…Patients present commonly with nonspecific morbilliform eruptions, but alternate clinical presentations reported with anti-PD-1/PD-L1 include psoriasis, 7–11 bullous pemphigoid (BP), 12–16 sarcoidosis, 17–19 and Stevens Johnson syndrome/toxic epidermal necrolysis. 20 For a detailed, comprehensive review of the broad array of presentations published to date, see Curry, et al 2016.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade

Kaunitz¹,

Loss²,

Rizvi³

et al. 2017

American Journal of Surgical Pathology

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Cutaneous eruptions are among the most common immune-related adverse events (irAEs) associated with anti-PD-1/PD-L1 therapy, and are often clinically and histologically characterized as lichenoid. Non-lichenoid patterns may also occur and are likely to be encountered by surgical pathologists, given the increasing clinical use of these agents. The purpose of this study is to describe the histopathologic features of non-lichenoid cutaneous irAEs from patients receiving anti-PD-1/PD-L1 therapies for a variety of underlying advanced malignancies. Sixteen patients with 17 biopsied eruptions were included from two academic institutions with extensive experience administering and monitoring responses to immune checkpoint blockade as well as treating the potential side effects. Eruptions occurred a median of 10 days (range 1 day to 11.4 months) after treatment initiation. Nearly half of specimens demonstrated either a psoriasiform/spongiotic or an urticarial-type reaction pattern on histologic review. Patterns consistent with Grover’s disease, bullous pemphigoid, and granulomatous dermatitis were also observed. Nearly two-thirds of patients required systemic corticosteroids for treatment of the cutaneous irAE, and 19% of patients discontinued immunotherapy due to their skin eruptions. 75% of patients showed an objective antitumor response. The diverse array of non-lichenoid cutaneous irAE presented here should reflect and inform the scope of histologic patterns encountered by the practicing surgical pathologist. Such eruptions are seen in patients with a variety of underlying tumor types, many of whom ultimately demonstrate a favorable response to immune checkpoint blockade.

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Autoimmune dermatologic toxicities from immune checkpoint blockade with anti‐PD‐1 antibody therapy: a report on bullous skin eruptions

Cited by 128 publications

References 14 publications

Debilitating Skin Toxicity Associated with Pembrolizumab Therapy in an 81-Year-Old Female with Malignant Melanoma

Debilitating Skin Toxicity Associated with Pembrolizumab Therapy in an 81-Year-Old Female with Malignant Melanoma

A review of bullous pemphigoid associated with PD‐1 and PD‐L1 inhibitors

Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade

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