Gargiulo Luigi, Ibba Luciano, Valenti Mario, Costanzo Antonio, Narcisi Alessandra
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele.
Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy.
Melanoma Res. 2023 Apr 1;33(2):152-154. doi: 10.1097/CMR.0000000000000875. Epub 2022 Dec 27.
Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, are monoclonal antibodies that block programmed cell death 1 (PD-1) expressed on activated CD8+ T cells and play a crucial role in the treatment of advanced melanoma. With the wide adoption of these therapies, a range of cutaneous adverse effects has been reported, such as flares of plaque psoriasis, but no specific guidelines regarding the treatment are available. We present the case of a 28-year-old male diagnosed with stage IV non-BRAFV600E mutated melanoma in 2014. After the surgery and the failure of ipilimumab and IL-2, he started immunotherapy with pembrolizumab. One month after the start of the therapy, he came to our department showing a severe flare of plaque psoriasis with a body surface area of 40% and a Psoriasis Area and Severity Index (PASI) of 28. Given the severity of the clinical picture and the contraindications to conventional systemic therapy, we decided to start biological treatment with risankizumab, an anti-IL-23 inhibitor. After just the induction phase, he showed almost skin clearance obtaining a reduction of more than 90% of the baseline PASI. Our patient's rapid response to risankizumab enabled us to continue immunotherapy with pembrolizumab. The recognition of cutaneous signs of toxicity related to such drugs for advanced melanoma is of primary importance to start the correct treatment and continue the immunotherapy when possible.
免疫检查点抑制剂，如帕博利珠单抗和纳武利尤单抗，是一类单克隆抗体，可阻断活化的CD8+T细胞上表达的程序性细胞死亡蛋白1（PD-1），在晚期黑色素瘤治疗中发挥关键作用。随着这些疗法的广泛应用，已报告了一系列皮肤不良反应，如斑块状银屑病发作，但尚无关于治疗的具体指南。我们报告一例28岁男性病例，其于2014年被诊断为IV期非BRAFV600E突变型黑色素瘤。在接受手术以及伊匹木单抗和白细胞介素-2治疗失败后，他开始使用帕博利珠单抗进行免疫治疗。治疗开始一个月后，他前来我院，表现为严重的斑块状银屑病发作，体表面积达40%，银屑病面积和严重程度指数（PASI）为28。鉴于临床表现的严重性以及传统全身治疗的禁忌证，我们决定开始使用抗白细胞介素-23抑制剂司库奇尤单抗进行生物治疗。仅在诱导期后，他的皮肤几乎完全清除，PASI较基线降低了90%以上。我们的患者对司库奇尤单抗的快速反应使我们能够继续使用帕博利珠单抗进行免疫治疗。识别与晚期黑色素瘤此类药物相关的皮肤毒性体征对于开始正确治疗并在可能的情况下继续免疫治疗至关重要。
