Thomas Mathew, Wazir Ali, Poudel Aarati
Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Oncology, State University of New York Upstate Medical University, Syracuse, USA.
Cureus. 2022 Jun 21;14(6):e26143. doi: 10.7759/cureus.26143. eCollection 2022 Jun.
The development of immune checkpoint inhibitors is considered to be one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-ligand 1 (PD-L1) receptor that has demonstrated antineoplastic activity against various malignancies including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab has been associated with significant dermatological adverse reactions, referred to as immune-related adverse events. The cutaneous adverse effects can affect the quality of life of the patient and can result in dose reduction or even discontinuation of the treatment. Hence it is of utmost importance to have a comprehensive understanding of the cutaneous toxicities for prompt initiation of treatment. We present the case of a 49-year-old male with metastatic non-small cell lung cancer (NSCLC) with 100% PD-L1 expression, who suffered a severe cutaneous reaction involving more than 95% of body surface area, following the first dose of pembrolizumab. He was treated with low-dose systemic steroids (prednisone 10 mg), to which he responded well. Since the patient showed excellent symptomatic and clinical response to pembrolizumab, it was not discontinued. The patient has not developed a rash with subsequent doses of pembrolizumab, and the steroids were tapered off.
免疫检查点抑制剂的研发被认为是癌症治疗领域最重要的进展之一。帕博利珠单抗是一种针对程序性死亡配体1（PD-L1）受体的免疫检查点抑制剂，已显示出对包括非小细胞肺癌、黑色素瘤和三阴性乳腺癌在内的多种恶性肿瘤具有抗肿瘤活性。帕博利珠单抗与显著的皮肤不良反应有关，称为免疫相关不良事件。皮肤不良反应会影响患者的生活质量，并可能导致剂量减少甚至治疗中断。因此，全面了解皮肤毒性对于及时开始治疗至关重要。我们报告一例49岁男性转移性非小细胞肺癌（NSCLC）患者，其PD-L1表达为100%，在首次使用帕博利珠单抗后出现严重皮肤反应，累及体表面积超过95%。他接受了低剂量全身性类固醇（泼尼松10毫克）治疗，反应良好。由于患者对帕博利珠单抗表现出出色的症状和临床反应，因此未停药。该患者在后续使用帕博利珠单抗时未出现皮疹，类固醇药物逐渐减量。
