McGovern Medical School, UT Health Science Center, Houston, TX.
Department of Dermatology, Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Lung Cancer. 2021 May;22(3):195-200.e1. doi: 10.1016/j.cllc.2021.01.006. Epub 2021 Jan 22.
Immune checkpoint inhibitors (ICPIs) have transformed the treatment of lung cancer in the recent years. However, disruption in immune homeostasis produces a unique spectrum of side effects termed as immune-related adverse events (irAEs). Cutaneous irAE are the most prevalent toxicity from the ICPIs. While there have been descriptions of the cutaneous irAEs from ICPIs in melanoma patients, observations are limited in non-small cell lung cancer (NSCLC). This is the largest single-institution cohort of NSCLC patients with cutaneous irAEs.
We conducted a retrospective chart review of our institution's electronic medical records from January 2017 to December 2018 with at least 1 year of follow up to characterize cutaneous adverse events induced by single agent anti PD-1/PD-L1 therapy in treatment of NSCLC.
In total, 64 patients (40 men and 24 female) were identified with cutaneous irAE. The median time-to-onset was 3 months. Eczematous, morbilliform, and acneiform rashes were most prevalent. There were 28 patients who had previous dermatologic conditions and only 4 of them had related cutaneous manifestations. Most patients' (70%) rashes improved or resolved after treatment with oral antihistamines and topical steroids. Eight (13%) of them had a dose impact to their cancer treatment due to their rash, with 4 (6%) patients discontinuing their ICPIs.
Cutaneous adverse events appears to be one of the most prevalent irAEs with ICPIs and has been reported with all anti PD-1/PD-L1 therapies. While in most cases these dermatologic adverse events remain self-limiting, they may cause treatment interruption and impact life quality. Recognition and early intervention may improve patient symptoms and therapy compliance.
免疫检查点抑制剂（ICPI）近年来改变了肺癌的治疗方式。然而，免疫稳态的破坏会产生一系列称为免疫相关不良反应（irAE）的独特副作用。皮肤 irAE 是 ICPI 最常见的毒性。虽然已经描述了黑色素瘤患者中来自 ICPI 的皮肤 irAE，但在非小细胞肺癌（NSCLC）中的观察结果有限。这是最大的 NSCLC 患者皮肤 irAE 单机构队列。
我们对本机构 2017 年 1 月至 2018 年 12 月的电子病历进行了回顾性图表审查，随访时间至少为 1 年，以描述单药抗 PD-1/PD-L1 治疗 NSCLC 时引起的皮肤不良反应。
共确定 64 例（40 名男性和 24 名女性）患者出现皮肤 irAE。中位发病时间为 3 个月。湿疹样、麻疹样和痤疮样皮疹最为常见。有 28 例患者既往有皮肤科疾病，但只有 4 例有相关的皮肤表现。大多数患者（70%）的皮疹在接受口服抗组胺药和局部类固醇治疗后得到改善或消退。8 例（13%）因皮疹影响癌症治疗剂量，其中 4 例（6%）患者停止使用 ICPI。
皮肤不良反应似乎是 ICPI 最常见的不良反应之一，并且已在所有抗 PD-1/PD-L1 治疗中报道。虽然在大多数情况下，这些皮肤不良反应是自限性的，但它们可能会导致治疗中断并影响生活质量。识别和早期干预可能会改善患者症状和治疗依从性。
