Inflammatory eruptions associated with immune checkpoint inhibitor therapy: A single-institutional, retrospective analysis with stratification of reactions by toxicity and implications for management

Publication date: Available online 3 November 2018

Source: Journal of the American Academy of Dermatology

Author(s): Emily Coleman, Christine Ko, Feng Dai, Mary M. Tomayko, Harriet Kluger, Jonathan S. Leventhal

Abstract

Background

There is increasing recognition of distinct inflammatory eruptions associated with checkpoint inhibitors. A better understanding of their severity, therapeutic response and impact on cancer treatment is needed.

Objective

To analyze the different rashes associated with immunotherapy referred to our institution's oncodermatology clinic and inpatient consultative service, and to evaluate their therapeutic response and impact on immunotherapy.

Methods

We retrospectively reviewed patients' medical records referred to the oncodermatology clinic or inpatient dermatology service between 2016-2018 at Yale-New Haven Hospital for eruptions that developed during immunotherapy.

Results

98 patients (51 men, 47 women) treated with checkpoint inhibitors developed 103 inflammatory eruptions, with a range of mean latency of 0.2-17.7 months. A minority (25/103; 24.3%) required immunotherapy interruption, most notably immunobullous (7/8; 87.5%), lichenoid (8/26; 30.8%), maculopapular (6/18; 33.3%), and SJS-like (2/2, 100%) reactions. Only 3/16 (18.8%) interrupted cases developed a grade 2 or 3 flare on rechallenge. Most reactions (93/103; 90.3%) responded to dermatologic therapy and/or immunotherapy interruption.

Limitations

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

Conclusion

A variety of inflammatory reactions may occur from immunotherapy with differing degrees of severity. While most rashes responded to topical treatment, immunobullous and exfoliative presentations frequently interrupted immunotherapy. Increased awareness and early recognition may reduce the need for unnecessary immunotherapy interruption.

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