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Ghamangiz S, Jafari A, Maleki-Kakelar H, Azimi H, Mazloomi E. Reprogram to heal: Macrophage phenotypes as living therapeutics. Life Sci 2025; 371:123601. [PMID: 40189197 DOI: 10.1016/j.lfs.2025.123601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 03/15/2025] [Accepted: 04/01/2025] [Indexed: 04/26/2025]
Abstract
Macrophages represent a crucial cell type within the immune system, exhibiting significant adaptability that allows for the transformation into various phenotypes in response to their surrounding environment. This review investigates the characteristics of various macrophage phenotypes and their functional roles in disease pathogenesis and resolution. The M1 phenotype, recognized for its inflammatory attributes, plays a pivotal role in combating infections and tumors; however, it may also contribute to tissue injury, persistent inflammation, and the pathogenesis of autoimmune and inflammatory diseases. Conversely, the M2 phenotype is associated with anti-inflammatory activities and tissue repair processes. But this is not the end of the story and researches illustrated novel phenotypes that may provide new approaches and therapeutic opportunities. Recent progress in characterizing distinct macrophage phenotypes has enabled the development of innovative therapeutic strategies for chronic inflammatory conditions, autoimmune disorders, and cancers. This review underscores the critical role of macrophage polarization, illustrating how various stimuli can influence macrophage fate and modify their responses. Additionally, it explores the implications of macrophage plasticity on disease progression and treatment efficacy. A comprehensive understanding of these dynamics is essential for the advancement of targeted immunotherapies, which possess the potential to transform treatment strategies for a variety of medical conditions.
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Affiliation(s)
- Sheyda Ghamangiz
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Abbas Jafari
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Maleki-Kakelar
- Solid Tumor Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Azimi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Ebrahim Mazloomi
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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2
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Lavin L, Geller S. Cutaneous T Cell Lymphoma Following Dupilumab Therapy in Patients with Atopic Dermatitis: Clinical Review and Recommendations. Am J Clin Dermatol 2025:10.1007/s40257-025-00955-7. [PMID: 40418285 DOI: 10.1007/s40257-025-00955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2025] [Indexed: 05/27/2025]
Abstract
The complex interplay between atopic dermatitis (AD) and cutaneous T cell lymphomas (CTCL) has been known as a matter of clinical concern. With the widespread use of dupilumab, a monoclonal antibody inhibiting interleukin-4 receptor alpha (IL-4Ra) and interleukin-13 receptor (IL-13R), potential association between dupilumab and developing CTCL has been reported in patients with AD. Disease progression has also been described in patients with known CTCL who were treated with dupilumab. Although population-based and pharmacovigilance data support an increased risk of CTCL with dupilumab use in patients with AD, it is a rare association, most likely occurring in predisposed patients. No evidence is available to support a direct oncogenic risk of transforming AD into lymphoma by the treatment, and current literature suggests the role of IL-4Ra/IL-13R inhibition in unmasking pre-existing malignant T cell clones through increased IL-13 availability. On the basis of a comprehensive literature review and our experience in a cutaneous lymphoma clinic at a tertiary cancer center, we provide practical clinical care recommendations for the use of dupilumab in patients with AD, CTCL, and non-skin lymphomas. We also highlight the need for further researching alternative diagnostic approaches to differentiate CTCL from AD and other inflammatory skin disorders and studying the roles of IL-13 and its receptors in CTCL and the effect of the newly available IL-13-inhibiting therapies.
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Affiliation(s)
- Leore Lavin
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, New York, NY, 10021, USA
| | - Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, New York, NY, 10021, USA.
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Koumprentziotis IA, Niforou A, Tsimpidakis A, Nikolaou C, Stratigos A, Nikolaou V. Dupilumab for the Treatment of Cutaneous Immune-Related Adverse Events: A Systematic Review. Int J Dermatol 2025. [PMID: 40375468 DOI: 10.1111/ijd.17850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 04/30/2025] [Accepted: 05/06/2025] [Indexed: 05/18/2025]
Abstract
The emergence of immune checkpoint inhibitors has revolutionized the landscape of cancer treatment in the modern era. However, cutaneous immune-related adverse events (cirAEs) are common, significantly affecting patients' quality of life and often leading to treatment discontinuation, which may compromise oncological outcomes. Dupilumab, an immunoglobulin G4 (IgG4) human monoclonal antibody targeting interleukin (IL)-4 and IL-13 receptors, is widely used for dermatologic conditions but remains unapproved for cirAEs due to the limited and scattered supporting evidence. This review aimed to summarize the available evidence regarding the use of dupilumab for the management of cirAEs. A systematic review was conducted using MEDLINE/PubMed, Scopus, and Web of Science in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In total, 25 publications met the eligibility criteria and were included, reporting 136 patients who were diagnosed with 140 cirAEs and were treated with dupilumab. The most frequently treated cirAEs were eczematous rashes, bullous pemphigoid, and maculopapular/morbilliform rashes. Dupilumab was found to be highly effective, with most patients achieving complete or partial responses, even when affected by two concomitant cirAEs. An acceptable safety profile was demonstrated regarding both adverse events and oncological safety, with no additional concerns to be raised. The findings may be encouraging but are limited by the relatively small number of patients treated and the nature of the included studies, with most of them being case reports and case series. More research is warranted, along with more clinical studies, prospective in design, focused on relevant clinical outcomes of this dupilumab-treated subset of patients.
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Affiliation(s)
- Ioannis-Alexios Koumprentziotis
- First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Niforou
- First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Tsimpidakis
- First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Alexander Stratigos
- First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vasiliki Nikolaou
- First Department of Dermatology, "Andreas Sygros" Hospital for Skin Diseases, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Khattab S, Wan G, Xu S, Moseley C, Tran M, Beagles E, Lin C, Leung BW, Azin M, Hao N, Reynolds KL, Demehri S, LeBoeuf NR, Semenov YR. Long-term mortality outcomes among immunotherapy recipients treated with dupilumab for the management of cutaneous immune-related adverse events. J Immunother Cancer 2025; 13:e010638. [PMID: 40355282 PMCID: PMC12083386 DOI: 10.1136/jitc-2024-010638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 04/23/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND Dupilumab has been added to National Cancer Comprehensive Network guidelines as a therapeutic strategy for managing certain cutaneous immune-related adverse events (cirAEs) from immune checkpoint blockade (ICB). However, little is known about the implications of dupilumab for cancer outcomes in this population. In this multi-institutional study, we evaluate the impact of dupilumab treatment on survival among ICB recipients. METHODS We conducted a multi-institutional retrospective cohort study of ICB recipients from the Mass General Brigham Healthcare System and Dana-Farber Cancer Institute. The dupilumab group was compared with two control groups who did not receive dupilumab: with and without cirAEs (control groups 1 and 2, respectively) that were 1:2 matched on sex, race, age at ICB initiation, Charlson Comorbidity Score, year of ICB initiation, and ICB type. Manual chart review was performed to obtain cirAE characteristics, systemic glucocorticoid use, dupilumab treatment, vital status, and last contact date. Time-varying multivariable Cox proportional hazards regressions were used to evaluate the impact of dupilumab on overall survival, adjusted for sex, race, age at ICB initiation, ICB type, Charlson Comorbidity Index score, cancer type, cancer stage at ICB initiation, and systemic glucocorticoid use. RESULTS A total of 53 cirAE patients treated with dupilumab were compared with two control groups of 106 patients each. Most patients receiving dupilumab demonstrated either complete or partial resolution of their cirAE (88.7%). In multivariable modeling, the overall survival of the dupilumab group was not significantly different from control group 1 (HR=0.74, 95% CI: 0.35 to 1.60, p=0.5) or control group 2 (HR=0.70, 95% CI: 0.32 to 1.51, p=0.4). However, the use of systemic glucocorticoids within 2 years after ICB initiation was associated with poorer overall survival when comparing the dupilumab group to control group 1 (HR=2.03, 95% CI: 1.04 to 3.96, p=0.039) and control group 2 (HR=2.21, 95% CI: 1.25 to 3.91, p=0.006). CONCLUSIONS This study suggests that dupilumab is an effective therapy for recalcitrant cirAEs and does not adversely impact mortality. Due to the observed detrimental effects of systemic glucocorticoid therapy, this study suggests the need to shift away from systemic glucocorticoid immunosuppression and toward targeted immune modulators for irAE management, though prospective randomized trials are necessary to investigate this.
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Affiliation(s)
- Sara Khattab
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Guihong Wan
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne Xu
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cameron Moseley
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew Tran
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emma Beagles
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chuck Lin
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bonnie W Leung
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marjan Azin
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ninghui Hao
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shadmehr Demehri
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole R LeBoeuf
- Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Dermatology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Yevgeniy R Semenov
- Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Gillis MC, Weir VR, Lezcano C, Iyer G, Gordon A. Use of dupilumab to manage a grade 3 cutaneous adverse effect from enfortumab vedotin/pembrolizumab treatment in a patient with metastatic urothelial carcinoma. JAAD Case Rep 2025; 56:40-44. [PMID: 39839459 PMCID: PMC11750431 DOI: 10.1016/j.jdcr.2024.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025] Open
Affiliation(s)
- Maura C. Gillis
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vanessa R. Weir
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gopa Iyer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Allison Gordon
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Lauletta G, Potestio L, Patruno C, De Lucia M, Napolitano M. Effectiveness and Safety of Dupilumab and Tralokinumab for Treating Atopic Dermatitis and Pruritic Skin Disorders in Oncological Patients: A Narrative Review. Clin Cosmet Investig Dermatol 2025; 18:311-317. [PMID: 39901963 PMCID: PMC11789671 DOI: 10.2147/ccid.s511559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 01/26/2025] [Indexed: 02/05/2025]
Abstract
Introduction Atopic dermatitis (AD) and pruritic skin disorders are increasingly recognized in cancer patients. The management of these conditions in patients with a history or with concomitant cancer presents unique challenges, as traditional systemic therapies may pose risks due to their immunosuppressive effects. In recent years, biologic agents such as dupilumab and tralokinumab have emerged as promising treatments for AD, offering targeted modulation of the immune response with potentially fewer systemic side effects. This article aims to review the current evidence on the safety and efficacy of dupilumab and tralokinumab in treating AD and pruritus among cancer survivors, addressing the potential benefits and considerations for this unique patient population. Methods A comprehensive analysis of the current medical literature was performed on the PubMed, Ovid, Scopus, Embase, and Cochrane Library databases until December 15, 2024. In conducting this narrative review, Medical Subject Headings (MeSH) terms and medical terminology related to clinical trials and real-life studies were employed, focusing on the pharmacological agents dupilumab, and tralokinumab. Discussion Patients with active or past cancer are typically excluded from clinical trials of new medications, complicating the evaluation of cancer progression or recurrence risks in these patients setting. The potential use of biologic drugs like dupilumab and tralokinumab in oncological patients marks a significant breakthrough for treating conditions such as eczema and pruritus, which are common in this patient group. Although there are no explicit contraindications for using dupilumab and tralokinumab in patients with active cancer or a history of malignancy, there is no definitive guidance on their use in such cases. Real-world data is emerging, facilitated by collaboration between dermatologists and oncologists, supporting the effectiveness and safety of dupilumab and tralokinumab for managing AD in cancer patients. Nonetheless, larger studies with longer follow-up periods and dedicated pharmacovigilance programs are needed to substantiate these findings.
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Affiliation(s)
- Giuseppe Lauletta
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Mario De Lucia
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Zhang X, Zhang B, Li D, Yang Y, Lin S, Zhao R, Li Y, Peng L. Peripheral blood cell counts as predictors of immune-related adverse events in cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis. Front Immunol 2025; 16:1528084. [PMID: 39949762 PMCID: PMC11821924 DOI: 10.3389/fimmu.2025.1528084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 01/13/2025] [Indexed: 02/16/2025] Open
Abstract
Background In recent years, immune checkpoint inhibitors (ICIs) have shown significant efficacy in treating various malignancies and have become a key therapeutic approach in cancer treatment. However, while ICIs activate the immune system, they can also induce immune-related adverse events (irAEs). Due to the variability in the frequency and severity of irAEs, clinical management faces a significant challenge in balancing antitumor efficacy with the risk of irAEs. Predicting and preventing irAEs during the early stages of treatment has become a critical research focus in cancer immunotherapy. This study aims to evaluate the predictive value of peripheral blood cell counts for irAEs. Methods Studies meeting the inclusion criteria were identified through database searches. The standardized mean difference (SMD) was used to compare continuous blood cell counts. For studies that did not provide adjusted odds ratios (ORs) and 95% confidence intervals (CIs), crude ORs for categorized blood cell counts were calculated. The study protocol was registered on PROSPERO (CRD42024592126). Results The meta-analysis included 60 studies involving 16,736 cancer patients treated with ICIs. Compared to patients without irAEs, those experiencing irAEs had significantly higher baseline continuous ALC (SMD = 0.12, 95% CI = 0.01-0.24), while ANC (SMD = -0.18, 95% CI = -0.28 to -0.07) and PLR (SMD = -0.32, 95% CI = -0.60 to -0.04) were significantly lower. Similarly, categorized blood cell counts indicated that higher baseline ALC (OR = 2.46, 95% CI = 1.69-3.57) and AEC (OR = 2.05, 95% CI = 1.09-3.85), along with lower baseline NLR (OR = 0.64, 95% CI = 0.50-0.81) and PLR (OR = 0.63, 95% CI = 0.48-0.82), were associated with an increased risk of irAEs. Subgroup analysis further identified cutoff values for ALC (2×10^9/L), NLR (5 or 3), and PLR (180) as better predictors of irAEs. Conclusion Higher baseline ALC and AEC, along with lower baseline ANC, NLR, and PLR, are associated with an increased risk of irAEs. However, further research is needed to determine the optimal cutoff values and to explore the efficacy of blood cell counts in predicting specific types of irAEs. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024592126.
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Affiliation(s)
- Xinyu Zhang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Bei Zhang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Danfei Li
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yunchao Yang
- Shandong College of Traditional Chinese Medicine, Shandong, Yantai, China
| | - Sen Lin
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Ruiqi Zhao
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yijia Li
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Lisheng Peng
- Department of Hepatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Chowdhury D, Chin L, Odabashian R, Fawaz A, Canil C, Ong M, Kirchhof MG, Reaume MN, Beltran-Bless AA, Savard MF, Tsoulis DJ, Bossé D. Diagnosis and Management of Skin Toxicities in Systemic Treatment of Genitourinary Cancers. Cancers (Basel) 2025; 17:251. [PMID: 39858032 PMCID: PMC11763385 DOI: 10.3390/cancers17020251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 01/05/2025] [Accepted: 01/09/2025] [Indexed: 01/27/2025] Open
Abstract
The landscape of available therapeutic options for treatment of genitourinary (GU) cancers is expanding dramatically. Many of these treatments have distinct, sometimes severe, skin toxicities including morbilliform, bullous, pustular, lichenoid, eczematous, psoriasiform, and palmoplantar eruptions. Pruritus and skin pigmentation changes have also been noted. This review aims to synthesize dermatologic events observed with antibody drug conjugates, poly (ADP-ribose) polymerase (PARP) inhibitors, androgen receptor pathway inhibitors, tyrosine kinase inhibitors, immune checkpoint inhibitors, and the combination of these agents used for the treatment of GU cancers. It provides a guide on diagnosis and initial management of these rashes for medical oncologists.
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Affiliation(s)
- Deepro Chowdhury
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
| | - Laura Chin
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Roupen Odabashian
- Department of Oncology, Wayne State University, Detroit, MI 48202, USA
| | - Ali Fawaz
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Christina Canil
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Michael Ong
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Mark G. Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Martin. Neil Reaume
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | | | - Marie-France Savard
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - David J. Tsoulis
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Dominick Bossé
- Division of Oncology, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
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Khattab S, Wan G, Xu S, Moseley C, Tran M, Beagles E, Lin C, Leung B, Azin M, Hao N, Reynolds KL, Demehri S, LeBoeuf NR, Semenov YR. Long-term mortality outcomes among immunotherapy recipients treated with dupilumab for the management of cutaneous immune-related adverse events. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.01.07.25320156. [PMID: 39830283 PMCID: PMC11741467 DOI: 10.1101/2025.01.07.25320156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
Background Dupilumab has been added to National Cancer Comprehensive Network (NCCN) guidelines as a therapeutic strategy for managing certain cutaneous immune-related adverse events (cirAEs) from immune checkpoint inhibitor (ICI) therapy. However, little is known about the implications of dupilumab for cancer outcomes in this population. In this multi-institutional study, we evaluate the impact of dupilumab treatment on survival among ICI recipients. Methods We conducted a muti-institutional retrospective cohort study of ICI recipients from the Mass General Brigham Healthcare System and Dana-Farber Cancer Institute. The dupilumab group was compared to two control groups who did not receive dupilumab: with and without cirAEs (control groups 1 and 2, respectively) that were 1:2 matched on sex, race, age at ICI initiation, Charlson Comorbidity Score, year of ICI initiation, and ICI type. Manual chart review was performed to obtain cirAE characteristics, systemic glucocorticoid use, dupilumab treatment, vital status, and last contact date. Time-varying multivariable Cox proportional hazards regressions were used to evaluate the impact of dupilumab on overall survival, adjusted for sex, race, age at ICI initiation, ICI type, Charlson Comorbidity Index score, cancer type, cancer stage at ICI initiation, and systemic glucocorticoid use. Results A total of 53 cirAE patients treated with dupilumab were compared to two control groups of 106 patients each. Most patients receiving dupilumab demonstrated either complete or partial resolution of their cirAE (88.7%). In multivariable modeling, the overall survival of the dupilumab group was not significantly different from control group 1 (HR=0.74, 95% CI:0.35-1.60, p=0.5) or control group 2 (HR=0.70, 95% CI:0.32-1.51, p=0.4). However, the use of systemic glucocorticoids within two years after ICI initiation was associated with poorer overall survival when comparing the dupilumab group to control group 1 (HR=2.03, 95% CI:1.04-3.96, p=0.039) and control group 2 (HR=2.21, 95% CI:1.25-3.91, p=0.006). Conclusions This study suggests that dupilumab is an effective therapeutic option for recalcitrant cirAEs and does not adversely impact mortality. Due to the observed detrimental effects of systemic glucocorticoid therapy, this study supports the need to shift away from systemic glucocorticoid immunosuppression and towards targeted immune modulators for irAE management that are less detrimental to ICI response. • What is already known on this topic Current guidelines recommend the use of dupilumab in the treatment of certain moderate to severe cutaneous immune related adverse events (cirAE) and systemic glucocorticoids for others. Previous studies have shown dupilumab to be effective for steroid refractory cirAEs; 1 however, the impact dupilumab on survival outcomes among recipients of immune checkpoint inhibitor therapy (ICI) remains under studied. • What this study adds This study concludes that dupilumab is an effective modality to treat cirAEs, with 88.7% of patients responding to treatment. Additionally, this study demonstrates a 206-day average delay from cirAE onset to dupilumab treatment suggesting the need for more timely consideration of this therapeutic option. Finally, our results demonstrated that dupilumab does not increase mortality among ICI recipients. • How this study might affect research practice or policy The results of this study suggest that use of dupilumab in the treatment of cirAEs is effective and does not adversely impact mortality in the cancer population. Based on these findings, clinicians should consider dupilumab treatment for cirAEs in the appropriate clinical setting. Moreover, this study provides further evidence for the use of targeted immune modulators as preferred over more commonly utilized broad-based glucocorticoid immunosuppression for the management of immune related adverse events in the setting of ICI therapy.
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Justice J, Kankaria RA, Johnson DB. Immune checkpoint inhibition of metastatic melanoma: achieving high efficacy in the face of high toxicity. Expert Rev Clin Pharmacol 2024; 17:1115-1125. [PMID: 39570086 DOI: 10.1080/17512433.2024.2431513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 11/15/2024] [Indexed: 11/22/2024]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have advanced the treatment of metastatic melanoma by blocking immune system down-regulators enhancing T-cell-mediated anti-tumor responses. However, many ICIs induce immune-related adverse effects (irAEs) that can impact many organ systems. AREAS COVERED Strategies used to manage irAEs include corticosteroids, anti-tumor necrosis factor alpha (TNF-α) agents, other biological therapies, fecal microbiota transplantation (FMT), and emerging regimens. In this review, we describe current evidence for the efficacy of ICIs, acute and chronic immune toxicities, and strategies to manage toxicities for patients treated with ICIs. EXPERT OPINION IrAE management will likely evolve by developing more tailored approaches to prevent toxicities, improving non-steroidal management strategies and tailoring the dose of steroids, and identifying biomarkers of severe toxicities.
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Affiliation(s)
- Joy Justice
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Roma A Kankaria
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Jiménez-Andrade Y, Flesher JL, Park JM. Cancer Therapy-induced Dermatotoxicity as a Window to Understanding Skin Immunity. Hematol Oncol Clin North Am 2024; 38:1011-1025. [PMID: 38866636 PMCID: PMC11368641 DOI: 10.1016/j.hoc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Pruritus, rash, and various other forms of dermatotoxicity are the most frequent adverse events among patients with cancer receiving targeted molecular therapy and immunotherapy. Immune checkpoint inhibitors, macrophage-targeting agents, and epidermal growth factor receptor/MEK inhibitors not only exert antitumor effects but also interfere with molecular pathways essential for skin immune homeostasis. Studying cancer therapy-induced dermatotoxicity helps us identify molecular mechanisms governing skin immunity and deepen our understanding of human biology. This review summarizes new mechanistic insights emerging from the analysis of cutaneous adverse events and discusses knowledge gaps that remain to be closed by future research.
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Affiliation(s)
- Yanek Jiménez-Andrade
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - Jessica L Flesher
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - Jin Mo Park
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth Street, Charlestown, MA 02129, USA.
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12
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Mima Y, Ohtsuka T, Ebato I, Nakata Y, Tsujita A, Nakazato Y, Norimatsu Y. Review of T Helper 2-Type Inflammatory Diseases Following Immune Checkpoint Inhibitor Treatment. Biomedicines 2024; 12:1886. [PMID: 39200350 PMCID: PMC11352049 DOI: 10.3390/biomedicines12081886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Immune checkpoints are mechanisms that allow cancer cells to evade immune surveillance and avoid destruction by the body's immune system. Tumor cells exploit immune checkpoint proteins to inhibit T cell activation, thus enhancing their resistance to immune attacks. Immune checkpoint inhibitors, like nivolumab, work by reactivating these suppressed T cells to target cancer cells. However, this reactivation can disrupt immune balance and cause immune-related adverse events. This report presents a rare case of prurigo nodularis that developed six months after administering nivolumab for lung adenocarcinoma. While immune-related adverse events are commonly linked to T helper-1- or T helper-17-type inflammations, T helper-2-type inflammatory reactions, as observed in our case, are unusual. The PD-1-PD-L1 pathway is typically associated with T helper-1 and 17 responses, whereas the PD-1-PD-L2 pathway is linked to T helper-2 responses. Inhibition of PD-1 can enhance PD-L1 functions, potentially shifting the immune response towards T helper-1 and 17 types, but it may also influence T helper-2-type inflammation. This study reviews T helper-2-type inflammatory diseases emerging from immune checkpoint inhibitor treatment, highlighting the novelty of our findings.
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Affiliation(s)
- Yoshihito Mima
- Department of Dermatology, Tokyo Metropolitan Police Hospital, Tokyo 164-8541, Japan
| | - Tsutomu Ohtsuka
- Department of Dermatology, International University of Health and Welfare Hospital, Tochigi 324-8501, Japan
| | - Ippei Ebato
- Department of Dermatology, International University of Health and Welfare Hospital, Tochigi 324-8501, Japan
| | - Yukihiro Nakata
- Department of Dermatology, International University of Health and Welfare Hospital, Tochigi 324-8501, Japan
| | - Akihiro Tsujita
- Department of Respiratory Medicine, International University of Health and Welfare Hospital, Tochigi 324-8501, Japan
| | - Yoshimasa Nakazato
- Department of Diagnostic Pathology, International University of Health and Welfare Hospital, Tochigi 324-8501, Japan
| | - Yuta Norimatsu
- Department of Dermatology, International University of Health and Welfare Narita Hospital, Chiba 286-0124, Japan;
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13
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Pach J, Valido K, Belzer A, Leventhal JS. The Use of Biologic Agents for the Treatment of Cutaneous Immune-Related Adverse Events from Immune Checkpoint Inhibitors: A Review of Reported Cases. Am J Clin Dermatol 2024; 25:595-607. [PMID: 38767827 DOI: 10.1007/s40257-024-00866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Cutaneous immune-related adverse events encompass a spectrum of dermatological manifestations, including lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus, vitiligo, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome. The conventional approach to treating high-grade or refractory cutaneous immune-related adverse events has involved high-dose systemic corticosteroids. However, their use is limited owing to the potential disruption of antitumor responses and associated complications. To address this, corticosteroid-sparing targeted immunomodulators have been explored as therapeutic alternatives. Biologic agents, commonly employed for non-cutaneous immune-related adverse events such as colitis, are increasingly recognized for their efficacy in treating various patterns of cutaneous immune-related adverse events, including psoriasiform, immunobullous, and Stevens-Johnson syndrome-like reactions. This review consolidates findings from the English-language literature, highlighting the use of biologic agents in managing diverse cutaneous immune-related adverse event patterns, also encompassing maculopapular, eczematous, and lichenoid eruptions, pruritus, and transient acantholytic dermatosis (Grover disease). Despite the established efficacy of these agents, further research is necessary to explore their long-term effects on antitumor responses.
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Affiliation(s)
- Jolanta Pach
- Yale University School of Medicine, New Haven, CT, USA
| | - Kailyn Valido
- Yale University School of Medicine, New Haven, CT, USA
| | - Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan S Leventhal
- Department of Dermatology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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14
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Metko D, Alkofide M, Abu-Hilal M. A real-world study of dupilumab in patients with atopic dermatitis including patients with malignancy and other medical comorbidities. JAAD Int 2024; 15:5-11. [PMID: 38371662 PMCID: PMC10869314 DOI: 10.1016/j.jdin.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
Background Dupilumab is a monoclonal antibody approved for the treatment of moderate-to-severe atopic dermatitis (MtS-AD). Various clinical trials have established the effectiveness and safety of dupilumab for the treatment MtS-AD; however, the real-world experiences of patients treated with dupilumab with malignancy and other comorbidities are lacking. Objective To assess the real-life effectiveness and safety of dupilumab in the treatment of MtS-AD within Canadian adult patient population, including those with other significant comorbidities such as malignancy. Methods In this retrospective study, records of adult patients diagnosed with MtS-AD, with a Physician Global Assessment (PGA) score of 3 or 4, and treated with dupilumab for 52 weeks were reviewed and collected. Results A total of 155 adult patients with atopic dermatitis (AD) treated with dupilumab were included in the study. Asthma was the most common comorbidity. One hundred twenty-three (80%) patients received either phototherapy and/or at least 1 systemic agent (methotrexate and cyclosporine) before initiation of dupilumab. PGA score of 0 or 1 was achieved by 64% of patients at week 52. Adverse effects including injection site reactions, ocular surface disease, facial and neck redness, and arthropathy occurred in 6%, 10%, 8%, and 6% of patients, respectively. Three patients continued receiving dupilumab throughout pregnancy, all maintaining PGA score of 0 or 1 with no impact on pregnancy, delivery, or the newborn. Twelve patients with prior or active malignancy were included, with no reported negative impact on malignancy. Conclusion Dupilumab is an effective and safe option for patients with AD in real life, including patients with malignancy and other medical comorbidities.
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Affiliation(s)
- Dea Metko
- Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - Maha Alkofide
- Division of Dermatology, McMaster University, Hamilton, Canada
| | - Mohannad Abu-Hilal
- Michael G. DeGroote School of Medicine, Hamilton, Canada
- Division of Dermatology, McMaster University, Hamilton, Canada
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15
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McClatchy J, Ross G. Dupilumab for atopic dermatitis in metastatic cancer. Australas J Dermatol 2024. [PMID: 38699896 DOI: 10.1111/ajd.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/04/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
We present a case of a 47-year-old male with severe atopic dermatitis and metastatic renal cell carcinoma managed successfully with dupilumab. This case further supports the safety of dupilumab in patients with active malignancy, an area currently with limited data.
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Affiliation(s)
- Jessica McClatchy
- Department of Dermatology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Gayle Ross
- Department of Dermatology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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16
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Saeed HN, Micheletti R, Phillips EJ. Editorial: Stevens Johnson syndrome: past, present, and future directions. Front Med (Lausanne) 2024; 11:1383891. [PMID: 38515984 PMCID: PMC10955758 DOI: 10.3389/fmed.2024.1383891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Hajirah N. Saeed
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, United States
| | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth J. Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia
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17
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Gu SL, Nath S, Markova A. Safety of Immunomodulatory Systemic Therapies Used in the Management of Immune-Related Cutaneous Adverse Events. Pharmaceuticals (Basel) 2023; 16:1610. [PMID: 38004475 PMCID: PMC10674388 DOI: 10.3390/ph16111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Immune-related cutaneous adverse events (ircAEs) commonly occur in patients on treatment with immune checkpoint inhibitors and can significantly reduce patient quality of life. These are often treated with immunomodulatory agents, including glucocorticoids, immunosuppressants, and biologics. While often effective at managing symptoms, these therapies can cause several adverse events which may limit their use. In addition, immunomodulatory agents should be used with particular caution in patients receiving immunotherapy, as the efficacy of the oncologic regimen may potentially be undermined. In this review, we summarize the safety of systemic therapies that are used in the management of ircAEs, with a particular focus on the resultant risk of secondary tumor progression in patients with active cancer.
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Affiliation(s)
- Stephanie L. Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sandy Nath
- Urgent Care Service, Memorial Sloan Kettering Cancer, New York, NY 10065, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065, USA
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18
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Kraehenbuehl L, Schneider S, Pawlik L, Mangana J, Cheng P, Dummer R, Meier-Schiesser B. Cutaneous Adverse Events of Systemic Melanoma Treatments: A Retrospective Single-Center Analysis. Pharmaceuticals (Basel) 2023; 16:935. [PMID: 37513847 PMCID: PMC10383648 DOI: 10.3390/ph16070935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/28/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Recent progress in the treatment of advanced melanoma has led to the improved survival of affected patients. However, novel treatments also lead to considerable and distinct skin toxicity. To further characterize cutaneous adverse events (AE) of systemic treatments, we conducted a single-center retrospective study of biopsy-proven cutaneous adverse events of melanoma treatment over a period of 10 years at the University Hospital of Zurich, Switzerland. In 102 identified patients, 135 individual skin AEs developed. Immune checkpoint blockade (ICB) was causal for 81 skin AEs, and 54 were related to targeted therapies (TT). Recorded types of skin AEs included lichenoid, maculopapular, acneiform, urticarial, panniculitis, folliculitis, psoriasiform, granulomatous, eczematous, and others. The incidence of skin AEs was higher with TT (18.54%) than with ICB (9.64%, p = 0.0029). Most AEs were low-grade, although 19.21% of AEs were common terminology criteria for adverse events (CTCAE) Grades 3 or 4. A large spectrum of skin AEs was documented during treatment of advanced melanoma, and distinct phenotypes were observed, depending on treatment classes. AEs occurred earlier during treatment with TT than with ICB, and distinct types of skin AEs were associated with respective treatment classes. This study comprehensively describes skin AEs occurring during systemic treatment for melanoma at a single center.
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Affiliation(s)
- Lukas Kraehenbuehl
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Stephanie Schneider
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Laura Pawlik
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Phil Cheng
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
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