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Abstract：
UNASSIGNED: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare yet life-threatening adverse events associated with immune checkpoint inhibitors (ICIs). This systematic review synthesizes the current literature to elucidate the clinical characteristics and outcomes of patients with ICI-related SJS/TEN.
UNASSIGNED: We conducted a thorough search across databases including Embase, Web of Science, Cochrane, MEDLINE, Scopus, and PubMed. Selection criteria focused on reports of SJS/TEN among cancer patients treated with ICIs, analyzing clinical manifestations, therapeutic interventions, and outcomes.
UNASSIGNED: Our analysis included 47 articles involving 50 patients with ICI-related SJS/TEN. The cohort had a mean age of 63 years, with a slight male predominance (54%). Most patients had melanoma or non-small cell lung cancer. SJS/TEN typically occurred early, with a median onset of 23 days post-ICI initiation. Treatment primarily involved systemic corticosteroids and intravenous immunoglobulins. The overall mortality rate was 20%, higher for TEN at 32%, with infections and tumor progression as leading causes. Median time from onset to death was 28 days. Survivors experienced a median re-epithelization time of 30 days, positively correlated with the extent of epidermal detachment (rs = 0.639, p = 0.009). Deceased patients exhibited a significantly higher proportion of TEN (90% vs. 48%, p = 0.029) and a larger epidermal detachment area (90% vs. 30% of the body surface area [BSA], p = 0.005) compared to survivors. The combination therapy group showed a higher proportion of TEN compared to corticosteroid monotherapy or non-corticosteroid therapy groups (72% vs. 29% and 50%, p = 0.01), with no significant differences in mortality or re-epithelization time. Dual ICI therapy resulted in a higher TEN rate than single therapy (100% vs. 50%, p = 0.028). Among single ICI therapies, the sintilimab-treated group trended towards a higher TEN rate (75% vs. 40-50%, p = 0.417), a larger detachment area (90% vs. 30-48% of BSA, p = 0.172), and a longer re-epithelization time (44 vs. 14-28 days, p = 0.036) compared to other ICI groups, while mortality rates remained similar.
UNASSIGNED: ICI-related SJS/TEN substantially impacts patient outcomes. Prospective clinical trials are critically needed to further clarify the pathogenesis and optimize therapeutic regimens.
UNASSIGNED: We conducted a thorough search across databases including Embase, Web of Science, Cochrane, MEDLINE, Scopus, and PubMed. Selection criteria focused on reports of SJS/TEN among cancer patients treated with ICIs, analyzing clinical manifestations, therapeutic interventions, and outcomes.
UNASSIGNED: Our analysis included 47 articles involving 50 patients with ICI-related SJS/TEN. The cohort had a mean age of 63 years, with a slight male predominance (54%). Most patients had melanoma or non-small cell lung cancer. SJS/TEN typically occurred early, with a median onset of 23 days post-ICI initiation. Treatment primarily involved systemic corticosteroids and intravenous immunoglobulins. The overall mortality rate was 20%, higher for TEN at 32%, with infections and tumor progression as leading causes. Median time from onset to death was 28 days. Survivors experienced a median re-epithelization time of 30 days, positively correlated with the extent of epidermal detachment (rs = 0.639, p = 0.009). Deceased patients exhibited a significantly higher proportion of TEN (90% vs. 48%, p = 0.029) and a larger epidermal detachment area (90% vs. 30% of the body surface area [BSA], p = 0.005) compared to survivors. The combination therapy group showed a higher proportion of TEN compared to corticosteroid monotherapy or non-corticosteroid therapy groups (72% vs. 29% and 50%, p = 0.01), with no significant differences in mortality or re-epithelization time. Dual ICI therapy resulted in a higher TEN rate than single therapy (100% vs. 50%, p = 0.028). Among single ICI therapies, the sintilimab-treated group trended towards a higher TEN rate (75% vs. 40-50%, p = 0.417), a larger detachment area (90% vs. 30-48% of BSA, p = 0.172), and a longer re-epithelization time (44 vs. 14-28 days, p = 0.036) compared to other ICI groups, while mortality rates remained similar.
UNASSIGNED: ICI-related SJS/TEN substantially impacts patient outcomes. Prospective clinical trials are critically needed to further clarify the pathogenesis and optimize therapeutic regimens.
摘要：
■Stevens-Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)是与免疫检查点抑制剂(ICIs)相关的罕见但危及生命的不良事件。本系统综述综合了目前的文献，以阐明ICI相关SJS/TEN患者的临床特征和预后。
■我们对包括Embase在内的数据库进行了彻底的搜索，WebofScience,科克伦,MEDLINE,Scopus,和PubMed。选择标准侧重于ICIs治疗的癌症患者中SJS/TEN的报告，分析临床表现，治疗性干预措施,和结果。
■我们的分析包括47篇文章，涉及50例ICI相关SJS/TEN患者。该队列的平均年龄为63岁，男性占主导地位（54％）。大多数患者患有黑色素瘤或非小细胞肺癌。SJS/TEN通常发生在早期，中位发病时间为ICI开始后23天。治疗主要涉及全身性皮质类固醇和静脉注射免疫球蛋白。总死亡率为20%，更高，为10％，为32％，以感染和肿瘤进展为主要原因。从发病到死亡的中位时间为28天。幸存者经历了30天的中位上皮再形成时间，与表皮脱离程度呈正相关(rs=0.639,p=0.009)。死亡患者的TEN比例明显更高(90%vs.48%,p=0.029)和较大的表皮脱离面积(90%vs.30%的体表面积[BSA]，p=0.005）与幸存者相比。与皮质类固醇单药或非皮质类固醇治疗组相比，联合治疗组的TEN比例更高（72％vs.29%和50%，p=0.01),在死亡率或再上皮化时间上没有显着差异。双重ICI治疗导致比单一治疗更高的TEN率(100%vs.50%,p=0.028)。在单一ICI疗法中，sintilimab治疗组的TEN率更高(75%vs.40-50%,p=0.417),更大的分离面积(90%与30-48%的BSA，p=0.172)，和更长的上皮再形成时间(44vs.14-28天,p=0.036）与其他ICI组相比，而死亡率仍然相似。
■与ICI相关的SJS/TEN显著影响患者预后。需要进行前瞻性临床试验以进一步阐明发病机制并优化治疗方案。
■我们对包括Embase在内的数据库进行了彻底的搜索，WebofScience,科克伦,MEDLINE,Scopus,和PubMed。选择标准侧重于ICIs治疗的癌症患者中SJS/TEN的报告，分析临床表现，治疗性干预措施,和结果。
■我们的分析包括47篇文章，涉及50例ICI相关SJS/TEN患者。该队列的平均年龄为63岁，男性占主导地位（54％）。大多数患者患有黑色素瘤或非小细胞肺癌。SJS/TEN通常发生在早期，中位发病时间为ICI开始后23天。治疗主要涉及全身性皮质类固醇和静脉注射免疫球蛋白。总死亡率为20%，更高，为10％，为32％，以感染和肿瘤进展为主要原因。从发病到死亡的中位时间为28天。幸存者经历了30天的中位上皮再形成时间，与表皮脱离程度呈正相关(rs=0.639,p=0.009)。死亡患者的TEN比例明显更高(90%vs.48%,p=0.029)和较大的表皮脱离面积(90%vs.30%的体表面积[BSA]，p=0.005）与幸存者相比。与皮质类固醇单药或非皮质类固醇治疗组相比，联合治疗组的TEN比例更高（72％vs.29%和50%，p=0.01),在死亡率或再上皮化时间上没有显着差异。双重ICI治疗导致比单一治疗更高的TEN率(100%vs.50%,p=0.028)。在单一ICI疗法中，sintilimab治疗组的TEN率更高(75%vs.40-50%,p=0.417),更大的分离面积(90%与30-48%的BSA，p=0.172)，和更长的上皮再形成时间(44vs.14-28天,p=0.036）与其他ICI组相比，而死亡率仍然相似。
■与ICI相关的SJS/TEN显著影响患者预后。需要进行前瞻性临床试验以进一步阐明发病机制并优化治疗方案。
