Trinidad Celestine, Nelson Kelly C, Glitza Oliva Isabella C, Torres-Cabala Carlos A, Nagarajan Priyadharsini, Tetzlaff Michael T, Ivan Doina, Hwu Wen-Jen, Prieto Victor G, Curry Jonathan L, Aung Phyu P
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Department of Anatomic Pathology, University of Santo Tomas Hospital Benavides Cancer Institute, Manila, Philippines.
J Cutan Pathol. 2018 Jul;45(7):504-507. doi: 10.1111/cup.13150. Epub 2018 Apr 23.
Immunotherapies targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1) have showed significant therapeutic benefit in patients with clinically advanced solid malignancies, including melanoma. However, immune-related adverse events (irAE) are common, and novel dermatologic toxicities continue to emerge as more patients are treated with immunotherapy. Here we describe a patient treated with combination immunotherapy of ipilimumab and pembrolizumab, who developed asymptomatic erythematous patches on both legs. Histopathologic examination revealed a cutaneous interstitial granulomatous dermatitis. Notably, our patient did not require cessation of immunotherapy for these lesions, which subsequently remained stable, while the patient's melanoma remained controlled. This case expands the dermatologic toxicity profile of immune checkpoint blockade, as recognition of such toxicities is critical to optimal patient management.
靶向细胞毒性T淋巴细胞相关抗原4（CTLA-4）、程序性细胞死亡蛋白1（PD-1）受体及其配体（PD-L1）的免疫疗法已在包括黑色素瘤在内的临床晚期实体恶性肿瘤患者中显示出显著的治疗益处。然而，免疫相关不良事件（irAE）很常见，随着越来越多的患者接受免疫治疗，新的皮肤毒性不断出现。在此，我们描述了一名接受伊匹单抗和帕博利珠单抗联合免疫治疗的患者，该患者双下肢出现无症状红斑斑块。组织病理学检查显示为皮肤间质肉芽肿性皮炎。值得注意的是，我们的患者并未因这些病变而需要停止免疫治疗，病变随后保持稳定，而患者的黑色素瘤仍得到控制。该病例扩展了免疫检查点阻断的皮肤毒性谱，因为认识到此类毒性对于优化患者管理至关重要。
