Rivet Valérian, Sibaud Vincent, Dion Jérémie, Duteurtre Salomé, Biteau Mélanie, Pages Cécile, Pastissier Andréa, Delavigne Karen, Cougoul Pierre, Rauzy Odile, Comont Thibault
Service de médecine interne et immuno-pathologie, IUCT - Oncopôle, CHU de Toulouse, 1, avenue Joliot-Curie, 31100 Toulouse, France.
Service d'oncodermatologie, IUCT - Oncopôle, CHU de Toulouse, Toulouse, France.
Rev Med Interne. 2024 Nov 22. doi: 10.1016/j.revmed.2024.11.011.
Immunological checkpoint inhibitors are now part of the oncological therapeutic arsenal in many solid cancers and malignant blood diseases, at the cost of immuno-mediated toxicities, of which dermatological disorders are among the most frequent. The most common, following treatment with anti-PD1 or anti-CTLA4, are maculopapular erythema, pruritus, vitiligo, or lichenoid lesions, but other more atypical conditions may lead to the internist being called upon. Here, we present a case series of these less common dermatological manifestations including fasciitis, dermatomyositis, scleroderma, granulomatosis and immune-induced vasculitis. Some manifestations appear similar to the primary forms or seem to correspond to paraneoplastic syndromes, but some diagnostic and therapeutic particularities are specific to ICI toxicity that the internist must be aware of.
免疫检查点抑制剂如今已成为许多实体癌和恶性血液病肿瘤治疗手段的一部分,代价是免疫介导的毒性反应,其中皮肤疾病最为常见。使用抗PD1或抗CTLA4治疗后,最常见的是斑丘疹性红斑、瘙痒症、白癜风或苔藓样病变,但其他更不典型的情况可能需要内科医生介入。在此,我们展示了一系列这些较不常见的皮肤表现病例,包括筋膜炎、皮肌炎、硬皮病、肉芽肿病和免疫性血管炎。一些表现看似与原发性形式相似,或似乎对应副肿瘤综合征,但内科医生必须了解一些特定于免疫检查点抑制剂毒性的诊断和治疗特殊性。