Department of Dermatology, Yale School of Medicine, New Haven, CT.
Yale J Biol Med. 2020 Mar 27;93(1):123-132. eCollection 2020 Mar.
The advent of immune checkpoint inhibition represents a paradigm shift in the treatment of an increasing number of cancers. However, the incredible therapeutic promise of immunotherapy brings with it the need to understand and manage its diverse array of potential adverse events. The skin is the most common site of immune-related adverse vents (irAEs), which can present with a wide variety of disparate morphologies and severities. These toxicities can endanger patient health and the ability to continue on therapy. This review summarizes our current understanding of the presentation and management of the most common and clinically significant cutaneous irAEs associated with immune checkpoint inhibitor (ICI) therapy. Effective management of these cutaneous irAEs requires an understanding of their morphology, their appropriate clinical characterization, and their potential prognostic significance. Their treatment is additionally complicated by the desire to minimize compromise of the patient's anti-neoplastic regimen and emphasizes the use of non-immunosuppressive interventions whenever possible. However, though cutaneous irAEs represent a challenge to both oncologist and dermatologist alike, they offer a unique glimpse into the mechanisms that underlie not only carcinogenesis, but many primary dermatoses, and may provide clues to the treatment of disease even beyond cancer.
免疫检查点抑制的出现代表了癌症治疗的一个范式转变。然而，免疫疗法令人难以置信的治疗前景带来了理解和管理其多样化的潜在不良事件的需要。皮肤是免疫相关不良事件（irAEs）最常见的部位，这些不良事件可能表现出各种各样的形态和严重程度。这些毒性可能危及患者的健康和继续治疗的能力。本综述总结了我们目前对与免疫检查点抑制剂（ICI）治疗相关的最常见和临床上最重要的皮肤 irAEs 的表现和管理的理解。有效管理这些皮肤 irAEs 需要了解它们的形态、适当的临床特征及其潜在的预后意义。由于希望尽量减少对患者抗肿瘤方案的影响，它们的治疗变得更加复杂，并强调在可能的情况下使用非免疫抑制干预措施。然而，尽管皮肤 irAEs 对肿瘤学家和皮肤科医生来说都是一个挑战，但它们提供了一个独特的视角，不仅可以了解癌症发生的机制，还可以了解许多原发性皮肤病的机制，并且可能为癌症以外的疾病治疗提供线索。
