PDF(Pubmed)
Abstract：
Immune checkpoint inhibitors (ICIs), a class of anticancer agents that upregulate T-cell response to tumor cells, are associated with immune-related adverse events (irAEs), and the skin is one of the most commonly affected organs. We report the first two cases of a unique ICI-induced clinicopathological entity. A psoriasiform-appearing eruption with psoriasiform, spongiotic, and lichenoid dermatitis pattern on histopathology. A 73-year-old male with stage IV melanoma treated with nivolumab and a 63-year-old female with stage IV colorectal cancer treated with pembrolizumab and TAK-981 separately presented to our clinic with a psoriasiform rash. In both patients, punch biopsy revealed an unusual combination of psoriasiform, spongiotic, and lichenoid dermatitis. Treatment with apremilast in the first patient yielded some improvement, while treatment with ixekizumab in the second patient yielded a complete resolution of the eruption. Our cases add to the growing body of reported immune toxicities related to ICI use and illustrate the utility of targeted immune suppression of pathways in disease phenotype to allow for ICI continuation and optimization of cancer treatment.
摘要：
免疫检查点抑制剂（ICIs），一类上调T细胞对肿瘤细胞反应的抗癌剂，与免疫相关不良事件（irAE）相关，皮肤是最常见的器官之一。我们报告了前两例独特的ICI诱导的临床病理实体。银屑病状出现的喷发，海绵状,和组织病理学上的苔藓样皮炎模式。一名73岁的男性患有IV期黑色素瘤，接受nivolumab治疗，一名63岁的女性患有IV期结直肠癌，接受pembrolizumab和TAK-981治疗，分别出现银屑病样皮疹。在这两个病人中，穿刺活检显示一种不寻常的银屑病组合，海绵状,和苔藓样皮炎.在第一位患者中使用apremilast的治疗取得了一些改善，而在第二名患者中使用ixekizumab的治疗完全消除了爆发。我们的病例增加了与ICI使用相关的免疫毒性的报道，并说明了疾病表型中途径的靶向免疫抑制的效用，以允许ICI的延续和癌症治疗的优化。
