Bullous disorders associated with anti-PD-1 and anti-PD-L1 therapy: A retrospective analysis evaluating the clinical and histopathologic features, frequency, and impact on cancer therapy

Publication date: Available online 17 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Jacob Siegel, Mariam Totonchy, William Damsky, Juliana Berk-Krauss, Frank Castiglione, Mario Sznol, Daniel P. Petrylak, Neal Fischbach, Sarah B. Goldberg, Roy H. Decker, Angeliki M. Stamatouli, Navid Hafez, Earl J. Glusac, Mary M. Tomayko, Jonathan S. Leventhal

Abstract

Background

Bullous disorders associated with anti-PD-1/PD-L1 therapy are increasingly reported and may pose distinct therapeutic challenges. Their frequency and impact on cancer therapy are not well established.

Objective

To evaluate the clinical and histopathologic findings, frequency, and impact on cancer therapy of bullous eruptions due to anti-PD-1/PD-L1 therapy.

Methods

We retrospectively reviewed the medical records of patients evaluated by the onco-dermatology clinic and consultative service of Yale New Haven Hospital from 2016 to 2018.

Results

We identified 9 patients who developed bullous eruptions of 853 patients (∼1%) treated with anti-PD-1/PD-L1 therapy at our institution during the study period: 7 presented with bullous pemphigoid, 1 presented with bullous lichenoid dermatitis, and 1 presented with linear IgA bullous dermatosis in the context of vancomycin therapy. 8 patients required systemic steroids, 5 required maintenance therapy, and 8 required interruption of immunotherapy. All 9 patients had an initial positive tumor response or stable disease, but 4 went on to develop disease progression.

Limitations

This was a retrospective study from a single tertiary care center.

Conclusion

Bullous disorders developed in approximately 1% of patients treated with anti-PD-1/PD-L1 therapy at our institution and frequently resulted in interruption of immune therapy and management with systemic corticosteroids and occasionally steroid-sparing agents.

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