Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management
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SPECIAL ARTICLE
Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe dermatological toxicities from checkpoint inhibitors Jennifer Choi 1 & Ronald Anderson 2 & Ada Blidner 3 & Tim Cooksley 4,5 & Michael Dougan 6,7 & Ilya Glezerman 8 & Pamela Ginex 9 & Monica Girotra 10,11 & Dipti Gupta 11 & Douglas Johnson 12 & Vickie R. Shannon 13 & Maria Suarez-Almazor 14 & Bernardo L. Rapoport 2,15 & Mario E. Lacouture 16 Received: 24 April 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Immune checkpoint inhibitors (ICIs) frequently result in cutaneous immune-related adverse events (IrAEs). Although the majority of these events are mild-to-moderate in severity, up to 5% are severe, which may lead to morbidity and dose interruption or discontinuation of ICI therapy. In addition, up to 25% of dermatologic IrAEs are corticosteroid-refractory or corticosteroiddependent. These 2020 MASCC recommendations cover the diagnosis and management of cutaneous IrAEs with a focus on moderate-to-severe and corticosteroid-resistant events. Although the usage of immune-suppressive therapy has been advocated in this setting, there is a lack of randomized clinical trial data to provide a compelling level of evidence of its therapeutic benefit. Keywords Bullous dermatoses . Corticosteroids . Cutaneous IrAEs . Inflammatory dermatitis . Pruritus . Skin rash . Vitiligo
Introduction Dermatologic toxicities secondary to anti-CTLA-4 and antiPD-1/anti-PD-L1 inhibitors are the most common immunerelated adverse events (IrAEs) among all organ systems. Rash, pruritus, and vitiligo are most frequently observed, while immunobullous reactions and severe cutaneous adverse * Bernardo L. Rapoport [email protected] Jennifer Choi [email protected] Ronald Anderson [email protected] Ada Blidner [email protected] Tim Cooksley [email protected] Michael Dougan [email protected] Ilya Glezerman [email protected]
events are less common, but are important to recognize and treat promptly. Rare adverse events (AEs) have been reported and continue to emerge daily. Cutaneous AEs may be a surrogate for clinical benefit; therefore, it is important to recognize these events and appropriately manage them, while trying to avoid discontinuation of immunotherapy if at all possible. With early diagnosis and prompt management, patients may
Pamela Ginex [email protected] Monica Girotra [email protected] Dipti Gupta [email protected] Douglas Johnson [email protected] Vickie R. Shannon [email protected] Maria Suarez-Almazor [email protected] Mario E. Lacouture [email protected] Extended author information available on the last page of the article
Support Care Cancer
be able to continue treatment with immune checkpoint inhibitors (ICIs), which may ultimately be crucial for overall treatment outcomes. However, it is also important to recognize potentially severe AEs and to know when to hold o
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