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L'Orphelin JM, Cassecuel J, Kandolf L, Harwood CA, Tookey P, Junejo MH, Hogan S, Lebbé C, Appalla Z, Kränke TM, Pellacani G, Cerasuolo D, Dujovic B, Del Marmol V, Forschner A, Garbe C, Bataille V, Ressler JM, Sollena P, Dompmartin A, Peris K, Dreno B. Cutaneous manifestations induced by check point inhibitors in 120 melanoma patients - The European MelSkinTox study. J Eur Acad Dermatol Venereol 2023. [PMID: 37042810 DOI: 10.1111/jdv.19112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/07/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Checkpoint inhibitors provide an effective approach for the melanoma treatment. They prolong lymphocyte effects, which explains the cytotoxicity underlying immune-related adverse events (IrAEs). Cutaneous IrAEs affect nearly 40% of PD-1i and 50% of CTLA4i treated patients. Severe cutaneous irAE do not often occur but could be life-threatening and may persist despite treatment discontinuation. METHODS We aim to investigate cutaneous IrAEs in a cohort of patients treated with ICI across Europe in an effort to characterize the reactions in a real-world, phase IV, post-marketing study using a follow-up questionnaire. Data since November 2016 until March 2021 were obtained from the Melskintox database, a European multicentric biobank dedicated to the follow-up of melanoma and cutaneous adverse events, supported by EADO. The dermatoses reported were pooled into 4 categories: inflammatory dermatosis, bullous diseases, drug-related eruptions and pigmentary diseases. RESULTS Inflammatory benign dermatoses (n=63) represented the most common group of reactions (52.5%), followed by drug-related eruptions (n=24, 20%), pigmentary diseases (n=23, 19.2%), and bullous diseases (n=10, 8.3%). Grade II (n=41, 34.2%) are represented by bullous pemphigoid, eczema, hypodermitis, lichenoid eruption, maculo-papular rash, pruritus, psoriasis-like rash, urticarial eruption and vitiligo. Grade III (n=18, 15.0%) are represented by bullous pemphigoid, lichenoid eruption, and rashes. Grade IV (n=2, 1.7%) is only represented by bullous disease. Most cutaneous IrAEs led to immunotherapy continuation (n=95, 88.0%). CR is associated with more severe the cutaneous irAEs. We report an average time-to-onset of 208 days and some late-onset events. CONCLUSION Our study has characterized the clinical spectrum of cutaneous irAEs, their timing and severity and their relationship with tumour response. Grade I-II cutaneous IrAE are easily managed allowing ongoing anti-cancer treatment. Severe late-onset cutaneous irAE are not uncommon. A dermatologic follow-up helps mitigate the risk of life-threatening adverse events. These findings highlight the importance of onco-dermatologic involvement in management of patients with melanoma receiving immunotherapy.
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Affiliation(s)
- J-M L'Orphelin
- Department of Dermatology, Caen-Normandie University Hospital, Caen, France
| | - J Cassecuel
- Nantes Université, Nantes - Angers INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, F-44000, Nantes, France
| | - L Kandolf
- Department of Dermatology, Medical Faculty Military Medical Academy, Crnotravska 17, 11000, Belgrade
| | - C A Harwood
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - P Tookey
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - M H Junejo
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - Sarah Hogan
- Department of Dermatology, Second Floor, South Tower, Royal London Hospital, Barts Health NHS Trust Whitechapel, E1 1 BB and Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, 4, Newark Street, E1 2AT, London
| | - C Lebbé
- Department of Dermatology, APHP Hôpital Saint Louis, 1 avenue Claude-Vellefaux, 75010, Paris
| | - Z Appalla
- Second Department of Dermatology, Aristotle University of Thessaloniki, Greece
| | - T-M Kränke
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A- 8036, Graz
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia via del Pozzo 71, 41124, Modena
| | - D Cerasuolo
- Biostatistics and Clinical Research Unit, Caen-Normandy University Hospital, Caen, France
| | - Branko Dujovic
- Department of Dermatology, Medical Faculty Military Medical Academy, Crnotravska 17, 11000, Belgrade
| | - V Del Marmol
- Department of Dermatology- Hôpital Erasme - Université Libre de Bruxelles - 808 route de Lennik - 1070, Bruxelles, Belgium
| | - A Forschner
- Department of Dermatology, Eberhard Karls University, Liebermeister Str. 25, 72076, Tuebingen, Germany
| | - C Garbe
- Department of Dermatology, Eberhard Karls University, Liebermeister Str. 25, 72076, Tuebingen, Germany
| | - V Bataille
- Department of Dermatology, Hemel Hempstead Hospital NHS, Hillfield Rd, HP2 4AD, London
| | - J M Ressler
- Department of Dermatology, Medical University of Vienna, Waehringerguertel 18-20, A-1090, Vienna
| | - P Sollena
- Department of Medical Science, Dermatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo a Gemelli 8, 00168, Rome, Italy
| | - A Dompmartin
- Department of Dermatology, Caen-Normandie University Hospital, Caen, France
| | - K Peris
- Department of Medical Science, Dermatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Largo a Gemelli 8, 00168, Rome, Italy
- Department of Dermatology, Catholic University of Rome, Largo F. Vito 1, 00168, Rome, Italy
| | - B Dreno
- Nantes Université, Nantes - Angers INSERM, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302, F-44000, Nantes, France
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Starzer AM, Kleinberger M, Feldmann K, Tomasich E, Hatziioannou T, Paiato C, Heller G, Kreminger J, Traint S, Steindl A, Ressler JM, Widhalm G, Gatterbauer B, Dieckmann K, Müllauer L, Preusser M, Berghoff AS. OS03.5.A Characterization of the inflammatory tumor microenvironment composition in solid cancer patients with brain metastases after progression to immune checkpoint inhibitor therapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Immunotherapy (IO) has changed the treatment landscape of metastatic cancer patients, however, treatment resistance is frequent. We aimed to characterize the inflammatory tumor microenvironment in brain metastases (BM) after IO to gain a deeper understanding of immunologic escape mechanisms.
Material and Methods
Solid cancer patients who had BM resection after IO progression (IO cohort) were retrospectively identified. We analyzed tumor-infiltrating immune cell subsets (CD3, CD8, CD45RO, FOXP3) and expression of immune checkpoint molecules (PD-L1, PD-1, LAG-3) by immunohistochemistry. A control cohort of BM tissue samples without prior IO served for comparison (no immunotherapy cohort, NIO).
Results
Twenty-eight IO patients (12/28, 42.9% females; 16/28, 57.1% males; median 61 years; 14/28, 50% lung cancer; 5/28, 17.9% melanoma; 4/28, 14.3% renal cell carcinoma; 1/28, 3.6% breast cancer; 4/28, 14.3% other cancer entities) and 57 NIO patients (28/57, 49.1% females; 29/57, 50.9% males; median 58 years; 35/57, 61.4% lung cancer; 9/57, 15.8% breast cancer; 4/57, 7.0% melanoma; 3/57, 5.3% renal cell carcinoma; 6/57, 10.5% other cancer entities) were included. IO patients had a median of one (range 0-4) systemic therapy line prior to IO. Median time from last IO application until BM resection was 5.6 months (range 0.2-49.8 months). Patients received a median number of 7 (range 1-56) IO applications (14/28, 50% PD-1-targeting IO; 8/28, 28.6% PD-L1; 2/28, 7.1% CTLA4; 4/28, 14.3% CTLA4+PD-1; 3/28, 10.7% IO+chemotherapy). No statistically significant differences in the densities of investigated TILs or PD-L1 expression between the IO and the NIO cohort were observed. Patients of the IO cohort showed higher PD-L1 expression compared to the NIO cohort (57.1 vs. 42.1%, Chi-square, p>0.05). Overall survival (OS) was similar in both cohorts, with a median OS of 11.0 months (range 5.0-17.0) in the IO cohort and 11.0 months (range 5.5-16.5) in the NIO cohort.
Conclusion
Our findings show an upregulation of PD-L1 in BM occurring after prior IO therapy in the absence of other overt changes in the inflammatory microenvironment. Ongoing analyses in this cohort are investigating possible molecular driver of resistance by analyzing DNA methylation profiles of pre-and post-IO tissue samples of the IO cohort to potentially gain insights on inflammatory IO resistance mechanisms in BM patients.
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Affiliation(s)
- A M Starzer
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - M Kleinberger
- Medical University of Vienna, Division of Oncology , Vienna , Austria
| | - K Feldmann
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - E Tomasich
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - T Hatziioannou
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - C Paiato
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - G Heller
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - J Kreminger
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - S Traint
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - A Steindl
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - J M Ressler
- Medical University of Vienna, Department of Dermatology , Vienna , Austria
| | - G Widhalm
- Medical University of Vienna, Department of Neurosurgery , Vienna , Austria
| | - B Gatterbauer
- Medical University of Vienna, Department of Neurosurgery , Vienna , Austria
| | - K Dieckmann
- Medical University of Vienna, Department of Radiotherapy , Vienna , Austria
| | - L Müllauer
- Medical University of Vienna, Department of Pathology , Vienna , Austria
| | - M Preusser
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
| | - A S Berghoff
- Medical University of Vienna, Division of Oncology , Vienna , Austria
- Christian Doppler Laboratory for Personalized Immunotherapy , Vienna , Austria
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