Characterization and evaluation of dermatological immune-mediated reactions associated with checkpoint inhibitors: an observational, longitudinal and retrospective study in an oncology service in Salvador/BA

Authors

DOI:

https://doi.org/10.30968/rbfhss.2024.152.1129

Abstract

Objective: To evaluate dermatological immune-mediated reactions in patients treated with checkpoint inhibitors at an oncology center in Salvador-BA. Method: An observational, longitudinal, retrospective, descriptive, and uncontrolled study was carried out in patients undergoing treatment with checkpoint inhibitors, during the period from Jan/2021 to Dec/2021. After applying the exclusion criteria, the study’s sample size resulted in 69 patients. Electronic spreadsheets from the Excel tool (Microsoft®) were used for data processing and statistical analysis. The identification and measurement of the severity of toxicities followed the Common Toxicity Criteria, as defined by the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Results: The investigation found 84 immunemediated dermatological reactions occurring in 44 patients (63.77%), with the most frequent being dry skin (37%), maculopapular rash (26%), and itching (20%).The regimen with the highest incidence of reactions was the one that included pembrolizumab, with 47 occurrences. The severity of dermatological immune-mediated toxicities ranged from grade 1 to grade 2, indicating a good safety profile for these medications. Key management strategies included the use of emollients, increased fluid intake, and administration of antihistamines and corticosteroids. Conclusion: The findings of this study are aligned with the evidence from the clinical literature and highlight the importance of in-depth understanding of factors related to immunotherapy toxicity, in order to detect these reactions prematurely, optimizing management and preventing more serious complications.

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References

Puzanov I, Diab A, Abdallah K, et al. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer, 2017; 5 (1): 95. DOI: 10.1186/s40425-017-0300-z

Wang JJ, Lei KF, Han F. Tumor microenvironment: recent advances in various cancer treatments. Eur Rev Med Pharmacol Sci, 2018; 22 (12): 3855-3864. DOI:10.26355/eurrev_201806_15270

Kumar V, Chaudhary N, Garg M, et al. Current Diagnosis and Management of Immune Related Adverse Events (irAEs) Induced by Immune Checkpoint Inhibitor Therapy. Front Pharmacol, 2017; 8 (49): 14. DOI: 10.3389/fphar.2017.00049

Ellis SR, Vierra AT, Millsop JW, et al. Dermatologic toxicities to immune checkpoint inhibitor therapy: A review of histopathologic features. J Am Acad Dermatol, 2020; 83 (4): 1130-1143. DOI: 10.1016/j.jaad.2020.04.105

Gong J, Chehrazi-Raffle A, Reddi S, et al. Development of PD-1 and PD-L1 inhibitors as a form of cancer immunotherapy: a comprehensive review of registration trials and future considerations. J Immunother Cancer. 2018; 6 (8): 1-18. DOI: 10.1186/s40425-018-0316-z

Loqtorzi®: solução injetável. Redwood City: Coherus BioSciences. [bula de medicamento]. 2023: 26. Available in: https://www.coherus.com/. Accessed on: 19st Dez 2023.

Zynyz®: solução injetável. Wilmington: Incyte Corporation. [bula de medicamento]. 2023: 20. Available in: https://incyte.com/. Accessed on: 19st Dez 2023.

Jemperli®: Solução para diluição. Responsável técnico Rafael Salles de Carvalho. Rio de Janeiro: GlaxoSmithKline Brasil Ltda. [bula de medicamento]. 2023: 15. Available in: https://br.gsk.com/. Accessed on: 19st Dez 2023.

Gault A, Anderson AE, Plummer R, et al. Cutaneous imune-related adverse events in patients with melanoma treated with checkpoint inhibitors. Br J Dermatol, 2021; 185 (2): 263–271. 021. DOI: 10.1111/bjd.19750

Geisler AN, Phillips GS, Barrios DM, et al. Immune checkpoint inhibitor: related dermatologic adverse events. J Am Acad Dermatol, 2020; 83 (5): 1255-1268. DOI: 10.1016/j.jaad.2020.03.132

Naidoo J, Page DB, Li BT, et al. Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Ann Oncol, 2015; 26 (12): 2375-2391. DOI: 10.1093/annonc/mdv383.

Wolchok JD, Kluger H, Callahan MK, et al. Nivolumab plus ipilimumab in advanced melanoma. N Engl J Med, 2013; 369 (2):122–133. DOI: 10.1056/NEJMoa1302369

Al-salama ZT. Durvalumab: A Review in Extensive-Stage SCLC. Target Oncol, 2022; 16 (6): 857–864. DOI: 10.1007/s11523-021-00843-0

Sibaud V. Dermatologic Reactions to Immune Checkpoint Inhibitors. Am J Clin Dermatol, 2017; 19 (3): 345–361. DOI: 10.1007/s40257-017-0336-3

Villadolid J, Amin A. Immune checkpoint inhibitors in clinical practice: update on management of immune-related toxicities. Transl Lung Cancer Res, 2015; 4 (5): 560–575. DOI: 10.3978/j.issn.2218-6751.2015.06.06

Common Terminology Criteria for Adverse Events (CTCAE). Version 5.0. U.S. National Institutes of Health National Cancer Institute. [s.l: s.n.]. Available in: <https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf>. Accessed on: 10st Dez 2023.

Published

2024-06-30

How to Cite

1.
ALMEIDA LB, WINGERT NR, BARBOSA IA. Characterization and evaluation of dermatological immune-mediated reactions associated with checkpoint inhibitors: an observational, longitudinal and retrospective study in an oncology service in Salvador/BA. Rev Bras Farm Hosp Serv Saude [Internet]. 2024Jun.30 [cited 2024Nov.22];15(2):e1129. Available from: https://rbfhss.org.br/sbrafh/article/view/1129

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ORIGINAL ARTICLES