Management of Immune-Related Cutaneous Adverse Reactions to PD-1 and PD-L1 Inhibitors for the Inpatient Dermatologist
- PDF / 857,129 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 50 Downloads / 169 Views
HOSPITAL-BASED DERMATOLOGY (L GUGGINA AND C NGUYEN, SECTION EDITORS)
Management of Immune-Related Cutaneous Adverse Reactions to PD-1 and PD-L1 Inhibitors for the Inpatient Dermatologist Simran Chadha 1 & Andrew J. Para 2 & Jennifer Choi 2 Accepted: 15 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors are immunotherapeutic agents associated with a range of auto-inflammatory cutaneous toxicities. This paper reviews the clinical approach to the diagnosis and management of immune-related cutaneous adverse events (irCAEs) to PD-1 and PD-L1 inhibitors, with emphasis on disease processes practitioners may encounter in hospitalized patients. Recent Findings A systematic approach for suspected irCAEs has been well-detailed in recent clinical guidelines. However, the breadth of irCAE manifestations and treatment options continues to be actively delineated in the literature. Summary The characterization and management of irCAEs is an ever-evolving realm of oncodermatology. The dermatologist’s role is to limit morbidity and mortality, maximize quality of life, and prevent discontinuation of immunotherapy. Non-steroidal immunomodulatory agents are being increasingly utilized for moderate to severe cutaneous reactions and present an opportunity for further research into safe and effective therapies. Keywords Immune-related adverse event . Immune-related cutaneous adverse event . Immune checkpoint inhibitor . PD-1 inhibitor . PD-L1 inhibitor . Oncodermatology
Introduction Immune checkpoint inhibitors (ICPi) are a class of immunotherapeutic agents that have revolutionized oncologic care within the past decade. This pharmacologic group includes monoclonal antibodies targeting PD-1 (nivolumab, pembrolizumab, cemiplimab) and PD-L1 (atezolizumab, avelumab, durvalumab), which are FDA-approved for an increasing number of malignancies. PD-1 and PD-L1 interaction between the T cell and tumor cell surface, respectively, leads to T cell exhaustion and resultant mitigation of the antitumor adaptive immune response.1–3 Intuitively, the anti-PD1 and anti-PD-L1 therapeutic antibodies that block this This article is part of the Topical Collection on Hospital-Based Dermatology * Jennifer Choi [email protected] 1
Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
2
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
binding lead to an increase in T cell anti-tumor activity. Inhibition of this interaction is not without cost, however, and auto-inflammatory toxicities are increasingly noted in the context of ICPi therapy. In the initial clinical trials, dermatologic side effects were common in patients receiving ICPi therapy, but the diagnoses reported were non-specific.4–6 Absolute risk of a cutaneous toxicity was around 30–40% for anti-PD-1 therapies per a systematic review of available randomized controlled trials (RC
Data Loading...
