Cure Alveolar Soft Part Sarcoma International (iCureASPS)

Dermatologic toxicities to immune checkpoint inhibitor therapy: A review of histopathologic features


Abstract

Antineoplastic agents that utilize the immune system have revolutionized cancer treatment. Specifically, implementation of immune checkpoint inhibitors, monoclonal antibodies that block cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), or programmed death ligand 1 (PD-L1), show improved and sustained responses in cancer patients. However, these agents are associated with a plethora of adverse events, many manifesting in the skin. As the clinical application of cancer immunotherapies expands, understanding the clinical and histopathologic features of associated cutaneous toxicities becomes increasingly important to dermatologists, oncologists, and pathologists to ensure timely diagnosis and appropriate care. This review discusses cutaneous reactions to immune checkpoint inhibitors, focusing on histopathologic features.

Keywords: checkpoint inhibitor, immunotherapy, CTLA-4, PD1, PD-L1, ipilimumab, nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, cutaneous, toxicity, adverse event, rash, skin, lichenoid dermatitis, bullous pemphigoid



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492441/

Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance

15 May 2019


Abstract

Immune-checkpoint inhibitors (ICIs), including anti-cytotoxic T lymphocyte antigen 4 (CTLA-4), anti-programmed cell death 1 (PD-1) and anti-programmed cell death 1 ligand 1 (PD-L1) antibodies, are arguably the most important development in cancer therapy over the past decade. The indications for these agents continue to expand across malignancies and disease settings, thus reshaping many of the previous standard-of-care approaches and bringing new hope to patients. One of the costs of these advances is the emergence of a new spectrum of immune-related adverse events (irAEs), which are often distinctly different from the classical chemotherapy-related toxicities. Owing to the growing use of ICIs in oncology, clinicians will increasingly be confronted with common but also rare irAEs; hence, awareness needs to be raised regarding the clinical presentation, diagnosis and management of these toxicities. In this Review, we provide an overview of the various types of irAEs that have emerged to date. We discuss the epidemiology of these events and their kinetics, risk factors, subtypes and pathophysiology, as well as new insights regarding screening and surveillance strategies. We also highlight the most important aspects of the management of irAEs.



https://www.nature.com/articles/s41571-019-0218-0