1
|
Merli M, Accorinti M, Romagnuolo M, Marzano A, Di Zenzo G, Moro F, Antiga E, Maglie R, Cozzani E, Parodi A, Gasparini G, Sollena P, De Simone C, Caproni M, Pisano L, Fattore D, Balestri R, Sena P, Vezzoli P, Teoli M, Ardigò M, Vassallo C, Michelerio A, Satta RR, Dika E, Melotti B, Ribero S, Quaglino P. Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience. Front Med (Lausanne) 2023; 10:1208418. [PMID: 37547602 PMCID: PMC10400335 DOI: 10.3389/fmed.2023.1208418] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue.
Collapse
Affiliation(s)
- Martina Merli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Martina Accorinti
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Angelo Marzano
- Dermatology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Francesco Moro
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
| | - Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Dermatology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Sollena
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Clara De Simone
- Dermatology Unit, Department of Surgical and Medical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dermatology Unit, University Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Luigi Pisano
- Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, Università Degli Studi di Napoli Federico II, Naples, Italy
| | - Riccardo Balestri
- Division of Dermatology, Outpatient Consultation for Rare Diseases, APSS, Trento, Italy
| | - Paolo Sena
- Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Pamela Vezzoli
- Dermatology Unit ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Miriam Teoli
- Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Marco Ardigò
- Porphyria and Rare Diseases, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Camilla Vassallo
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Michelerio
- Dermatology Unit, Ospedale Cardinal Massaia, Asti, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rosanna Rita Satta
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Emi Dika
- Melanoma Center, Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Unit of Dermatology, Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Barbara Melotti
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Zhang J, Wang SH, Zuo YG. Paradoxical phenomena of bullous pemphigoid induced and treated by identical biologics. Front Immunol 2023; 13:1050373. [PMID: 36685489 PMCID: PMC9849796 DOI: 10.3389/fimmu.2022.1050373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
Objective This study aimed to investigate the clinical features of biologics-induced bullous pemphigoid (BP) and the therapeutic effects of those agents for BP, exploring the underlying pathophysiological mechanisms. Methods We searched PubMed, Web of Science, and Elsevier for studies involving pemphigoid patients treated with or induced by identical biologics published in English from January 2009 to April 2022. Results Seventeen cases of drug-induced BP associated with anti-tumor necrosis factor (aTNF)-α therapies, one with interleukin (IL)-17 inhibitors, and seven with IL-12/IL-23 or IL-23 inhibitors were enrolled. Time to cutaneous toxicity varied among different types of agents, and the characteristics of clinical examinations were similar to idiopathic BP. Discontinuation of the culprit drugs and initiation of topical or systemic corticosteroids were adequate in most cases. Several monoclonal antibodies above have also been reported for the treatment of refractory or recurrent BP, especially concurrent with psoriasis. Conclusion Biologics for immune-related diseases, including TNF-α, IL-17, and IL-12/IL-23 or IL-23 inhibitors, can both induce and treat BP, which might be associated with a helper T cells Th1/Th2 imbalance, complicated inflammatory networks, and a specific individual microenvironment, suggestive of a new perspective on the therapeutic algorithms of BP. There have been numerous reports about biologics inducing or treating BP. We have taken note of this phenomenon and focused on biologics with both pathogenetic and therapeutic effects on BP. Our review summarized the clinical characteristics of associated cases, trying to figure out the underlying mechanisms of this paradoxical phenomenon and to provide an integrated perspective and new therapeutic alternatives for BP.
Collapse
|
3
|
Molle MF, Capurro N, Herzum A, Micalizzi C, Cozzani E, Parodi A. Self-resolving bullous pemphigoid induced by cemiplimab. Dermatol Ther 2022; 35:e15466. [PMID: 35320611 PMCID: PMC9285614 DOI: 10.1111/dth.15466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Mattia Fabio Molle
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San, Martino, IRCCS, Genoa, Italy
| | - Niccolò Capurro
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San, Martino, IRCCS, Genoa, Italy
| | - Astrid Herzum
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San, Martino, IRCCS, Genoa, Italy
| | - Claudia Micalizzi
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San, Martino, IRCCS, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San, Martino, IRCCS, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San, Martino, IRCCS, Genoa, Italy
| |
Collapse
|