Voudouri Dimitra, Nikolaou Vasiliki, Laschos Konstantinos, Charpidou Andriani, Soupos Nikolaos, Triantafyllopoulou Ioanna, Panoutsopoulou Ioanna, Aravantinos Gerasimos, Syrigos K, Stratigos A
Dermato Oncology Department, Cutaneous Toxicities Clinic, Andreas Sygros Hospital, University of Athens, Athens, Greece.
Dermato Oncology Department, Cutaneous Toxicities Clinic, Andreas Sygros Hospital, University of Athens, Athens, Greece.
Curr Probl Cancer. 2017 Nov-Dec;41(6):407-412. doi: 10.1016/j.currproblcancer.2017.10.003. Epub 2017 Oct 18.
Immune checkpoint inhibitors are novel agents approved for the treatment of late-stage malignancies. Despite its important clinical benefits, checkpoint inhibition is associated with a unique spectrum of side effects known as immune-related adverse events. Skin toxicities are the most frequent immune-related adverse events during anti-PD1 blockade therapies. Among them, rare cases of psoriasis exacerbation have been reported.
We present the clinical characteristics of exacerbated psoriasis in 5 patients under anti-PD1/PDL1 therapy.
A total of 5 patients were overall included (4 males, 1 female mean age 65.8 years). Among them, 3 were diagnosed with nonsmall cell lung cancer, 1 with papillary urothelial carcinoma, and 1 with squamous cell carcinoma of the tonsil. Of all, 3 patients were treated with anti-PD1 (1 with pembrolizumab, 2 with nivolumab), whereas the remaining 2 with anti-PDL1 (durvalumab). Only 1 out of 5 patients had active psoriatic lesions at the time of treatment initiation, 2 shared a past history of psoriasis, and 1 reported a strong related family history (3/5 siblings). Four out of 5 patients experienced guttate lesions, though the most severe exacerbation was noted in the durvalumab group. Four out of 5 patients managed to continue treatment after close dermatologic monitoring, whereas 1 patient under durvalumab was forced to treatment delays owing to the severity of the skin reactions. Skin rashes appeared in all patients after the fourth cycle of immunotherapy.
Both anti-PD1 and anti-PDL1 therapies can lead to psoriasis exacerbation although more severe flares were noted in patients treated with durvalumab. Not only personal but also related family history of psoriasis are significant risk factors and need to be outlined before treatment initiation. If such related history exists, strict skin surveillance can lead to the early diagnosis and treatment of any psoriatic exacerbations that could otherwise severely affect quality of life or even compromise therapeutic protocols and final prognosis.
免疫检查点抑制剂是被批准用于治疗晚期恶性肿瘤的新型药物。尽管其具有重要的临床益处，但检查点抑制与一系列独特的副作用相关，这些副作用被称为免疫相关不良事件。皮肤毒性是抗PD1阻断治疗期间最常见的免疫相关不良事件。其中，已有银屑病加重的罕见病例报道。
我们介绍了5例接受抗PD1/PDL1治疗的银屑病加重患者的临床特征。
共纳入5例患者（4例男性，1例女性，平均年龄65.8岁）。其中，3例被诊断为非小细胞肺癌，1例为乳头状尿路上皮癌，1例为扁桃体鳞状细胞癌。所有患者中，3例接受抗PD1治疗（1例使用派姆单抗，2例使用纳武单抗），其余2例接受抗PDL1治疗（度伐利尤单抗）。5例患者中只有1例在开始治疗时患有活动性银屑病皮损，2例有银屑病病史，1例报告有强烈的家族相关病史（5个兄弟姐妹中有3个患病）。5例患者中有4例出现点滴状皮损，不过度伐利尤单抗组的病情加重最为严重。5例患者中有4例在密切的皮肤科监测后得以继续治疗，而1例接受度伐利尤单抗治疗的患者因皮肤反应严重而被迫延迟治疗。所有患者在免疫治疗的第四个周期后均出现皮疹。
抗PD1和抗PDL1治疗均可导致银屑病加重，不过度伐利尤单抗治疗的患者皮疹发作更为严重。银屑病的个人病史及家族相关病史均为重要的危险因素，在开始治疗前需要明确。如果存在此类相关病史，严格的皮肤监测可实现对任何银屑病加重情况的早期诊断和治疗，否则可能严重影响生活质量，甚至危及治疗方案和最终预后。
