1
|
Marques-Piubelli ML, Seervai RNH, Mudaliar KM, Ma W, Milton DR, Wang J, Muhlbauer A, Parra ER, Solis LM, Nagarajan P, Speiser J, Hudgens C, Cho WC, Aung PP, Patel A, Pacha O, Nelson KC, Tetzlaff MT, Amaria RN, Torres-Cabala CA, Prieto VG, Wistuba II, Curry JL. Gene expression profiling and multiplex immunofluorescence analysis of bullous pemphigoid immune-related adverse event reveal upregulation of toll-like receptor 4/complement-induced innate immune response and increased density of T H 1 T-cells. J Cutan Pathol 2023. [PMID: 37150813 DOI: 10.1111/cup.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/22/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI)-based cancer therapies cause a variety of cutaneous immune-related adverse events (irAEs) including immunobullous skin eruptions like bullous pemphigoid (BP). However, little is known about the underlying immunopathogenic drivers of these reactions, and understanding the unique gene expression profile and immune composition of BP-irAE remains a critical knowledge gap in the field of oncodermatology/oncodermatopathology. METHODS BP-irAE (n = 8) and de novo BP control (n = 8) biopsy samples were subjected to gene expression profiling using the NanoString® Technologies nCounter PanCancer Immune Profiling Panel. Multiplex immunofluorescence (mIF) studies using markers for T-cells (CD3 and CD8), T helper 1 (TH 1) cells (Tbet), TH 2 cells (Gata3), TH 17 cells (RORγT), and regulatory T-cells (Tregs; FoxP3) were further evaluated using InForm® image analysis. RESULTS Compared with de novo BP controls, BP-irAE samples exhibited upregulation of 30 mRNA transcripts (p < 0.025), including toll-like receptor 4 (TLR4) and genes associated with complement activation, and downregulation of 89 mRNA transcripts (p < 0.025), including genes associated with TH 2, TH 17, and B-cell immune response. BP-irAE demonstrated a greater density of Tbet+ (TH 1) cells in the dermis (p = 0.004) and fewer Tregs in the blister floor (p = 0.028) when compared with that of de novo control BP samples. CONCLUSIONS BP-irAE exhibited activation of the TLR4/complement-driven classical innate immune response pathway, with dermal TH 1 immune cell polarization and decreased Tregs in the blister floor. TLR/complement signaling may underlie the immunopathogenesis of BP-irAE.
Collapse
Affiliation(s)
- Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Riyad N H Seervai
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
- Internal Medicine Residency Program, Providence Portland Medical Center, Portland, Oregon, USA
| | - Kumaran M Mudaliar
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Wencai Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aaron Muhlbauer
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Edwin R Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Luisa M Solis
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jodi Speiser
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Courtney Hudgens
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anisha Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Omar Pacha
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael T Tetzlaff
- Departments of Pathology and Dermatology, Oral Pathology and Dermatopathology Unit, The University of California San Francisco, San Francisco, California, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
2
|
Bur D, Patel AB, Nelson K, Huen A, Pacha O, Phillips R, Heberton M. A retrospective case series of 20 patients with immunotherapy-induced bullous pemphigoid with emphasis on management outcomes. J Am Acad Dermatol 2022; 87:1394-1395. [PMID: 35940366 DOI: 10.1016/j.jaad.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 07/15/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Delfina Bur
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Anisha B Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Kelly Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auris Huen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Omar Pacha
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rhea Phillips
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meghan Heberton
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
3
|
Dao EA, George SJ, Heberton MM, Pacha O, Kovitz CA, Patel AB, Phillips RM. Erratum to "Periorbital edema associated with alpelisib" [Cancer Treatment and Research Communications 32 (2022) 100596]. Cancer Treat Res Commun 2022; 33:100654. [PMID: 36463021 DOI: 10.1016/j.ctarc.2022.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Elizabeth A Dao
- Louisiana State University Health Sciences Center School of Medicine, 2020 Gravier St., New Orleans, LA, 70112, USA.
| | - Saira J George
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX, 77030, USA; Department of Dermatology, The University of Texas Health Science Center at Houston, 6655 Travis Street, Suite 700, Houston, TX, 77030, USA
| | - Meghan M Heberton
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX, 77030, USA
| | - Omar Pacha
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX, 77030, USA
| | - Craig A Kovitz
- Department of Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Anisha B Patel
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX, 77030, USA; Department of Dermatology, The University of Texas Health Science Center at Houston, 6655 Travis Street, Suite 700, Houston, TX, 77030, USA
| | - Rhea M Phillips
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX, 77030, USA; Department of Dermatology, The University of Texas Health Science Center at Houston, 6655 Travis Street, Suite 700, Houston, TX, 77030, USA
| |
Collapse
|
4
|
Dao EA, George SJ, Heberton MM, Pacha O, Kovitz CA, Patel AB, Phillips RM. Periorbital edema associated with alpelisib. Cancer Treat Res Commun 2022; 32:100596. [PMID: 35834907 DOI: 10.1016/j.ctarc.2022.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Alpelisib is an alpha isoform-specific phosphatidylinositol 3-kinase (PI3K) inhibitor approved for use in the treatment of hormone receptor (HR)-positive, human epidermal growth factor receptor (HER2)-negative metastatic breast cancer in combination with fulvestrant. Hyperglycemia, rash, and gastrointestinal upset are the most commonly reported adverse events associated with alpelisib. Although rash is a known on-target effect of alpelisib, patients typically present with a morbilliform rash. We describe two cases of periorbital edema associated with alpelisib. We discuss the clinical findings, management, and prognosis of this unique reaction. These cases highlight the importance of early involvement of dermatology to manage adverse cutaneous events associated with alpelisib.
Collapse
Affiliation(s)
- Elizabeth A Dao
- Louisiana State University Health Sciences Center School of Medicine, 2020 Gravier St., New Orleans, LA 70112, USA.
| | - Saira J George
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX 77030, USA; Department of Dermatology, The University of Texas Health Science Center at Houston, 6655 Travis Street, Suite 700, Houston, TX 77030, USA
| | - Meghan M Heberton
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX 77030, USA
| | - Omar Pacha
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX 77030, USA
| | - Craig A Kovitz
- Department of Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Anisha B Patel
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX 77030, USA; Department of Dermatology, The University of Texas Health Science Center at Houston, 6655 Travis Street, Suite 700, Houston, TX 77030, USA
| | - Rhea M Phillips
- Department of Dermatology, Faculty Center Tower, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Floor 11, Box 1452, Houston, TX 77030, USA; Department of Dermatology, The University of Texas Health Science Center at Houston, 6655 Travis Street, Suite 700, Houston, TX 77030, USA
| |
Collapse
|
5
|
Patel AB, Farooq S, Welborn M, Amaria RN, Chon SY, Diab A, Glitza Oliva IC, Huen AO, Li SQ, Nelson KC, Pacha O, Patel SP, Rapini RP, Tawbi HA, Wong MK, McQuade J, Davies MA, Haydu LE. Cutaneous adverse events in 155 patients with metastatic melanoma consecutively treated with anti-CTLA4 and anti-PD1 combination immunotherapy: Incidence, management, and clinical benefit. Cancer 2022; 128:975-983. [PMID: 34724197 DOI: 10.1002/cncr.34004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In response to the increased use of combination checkpoint inhibitors (CPIs) and the resulting increased cutaneous adverse events (CAEs), this study reviewed patients with melanoma treated with combination CPIs to characterize CAE features and their clinical impact, correlation to adverse events in other organs, and correlation to tumor response. METHODS Patients from the authors' institutional database who received at least 1 dose of ipilimumab in combination with either nivolumab or pembrolizumab between January 1, 2012, and December 31, 2017, for stage IV or unresectable stage III melanoma were identified. The time to next treatment (TTNT) was calculated from the start of CPI therapy to the start of the next treatment or death, and the development of CAEs was tested in a time-dependent Cox regression to identify associations with TTNT. RESULTS Eighty-one patients (52.3%) experienced a total of 92 CAEs, including eczematous dermatitis (25.0%), morbilliform eruption (22.8%), vitiligo (12.0%), and pruritus without rash (8.7%). The median times to the onset and resolution of CAEs were 21 days (range, 0-341 days) and 50 days (range, 1-352 days), respectively. Most CAEs resolved after patients entered the CPI maintenance phase and treatment with oral antihistamines with or without topical steroids. CPI discontinuation occurred in 4 patients (2.6%) because of CAEs, in 49 (31.6%) because of other immune-related adverse events, and in 20 (12.9%) because of melanoma progression or death. For patients definitively treated with CPIs (n = 134; 86.5%), TTNT was significantly longer with CAEs than without CAEs (hazard ratio, 0.567; 95% CI, 0.331-0.972; P = .039). CONCLUSIONS CAEs were mostly reversible and rarely required therapy discontinuation. The development of CAEs was associated with a longer TTNT, and this suggested a possible clinical benefit.
Collapse
Affiliation(s)
- Anisha B Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Sahira Farooq
- McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Macartney Welborn
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan Y Chon
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adi Diab
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auris O Huen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Omar Pacha
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sapna P Patel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ronald P Rapini
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael K Wong
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lauren E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
6
|
Lo JJ, Heberton MM, Pacha O, Huen AO, Patel AB. Biologic therapies for checkpoint inhibitor-induced cutaneous toxicities: a single-institution study of 17 consecutively treated patients. Support Care Cancer 2021; 30:989-994. [PMID: 34519869 DOI: 10.1007/s00520-021-06548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/07/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Treatment options for corticosteroid-refractory and/or high-grade checkpoint inhibitor (CPI)-induced cutaneous adverse events (CAEs) are limited; however, anecdotal reports of biologic therapies have been successful. We aim to characterize the appropriate treatment scenarios and safety and efficacy profiles of biologics used to treat patients with CPI-induced CAEs at a single institution. METHODS This is a retrospective case series of patients from January 1st, 2015 to October 20th, 2020, with CPI-induced CAEs who were treated with biologics at a single cancer center. Patients were identified using institutional electronic medical record who underwent CPI therapy with subsequent CAEs that necessitated biologic therapy. Diagnostic criteria utilized for CAEs were based on documentation by four board-certified dermatologists, in combination with detailed chart reviews and pathology findings. Primary study outcome measurements include CAE response, tumor response, and adverse events during biologics treatment. RESULTS We identified 17 patients who fit study criteria. Sixteen patients experienced some degree of CAE improvement on biologics, with 10 of 10 patients reaching CAE resolution at 6 months post biologics. Eight patients needed new systemic treatment post biologics treatment, while 9 patients received no further treatment or stayed on the CPI. Thirteen patients tolerated biologics well with no significant adverse events or blood abnormalities, with only 2 patients experiencing biologic dose delays. CONCLUSION In our cohort, biologics appear to be extremely efficacious in the treatment of severe-grade and/or steroid refractory CAEs. They also appeared to be well-tolerated without overtly negative effects on tumor response. In patients with limited cancer treatment options and good tumor response to CPIs, biologics should be considered for severe-grade and/or refractory CAEs.
Collapse
Affiliation(s)
| | - Meghan M Heberton
- Department of Dermatology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1452, Houston, TX, 77030-4009, USA
| | - Omar Pacha
- Department of Dermatology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1452, Houston, TX, 77030-4009, USA
| | - Auris O Huen
- Department of Dermatology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1452, Houston, TX, 77030-4009, USA
| | - Anisha B Patel
- Department of Dermatology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1452, Houston, TX, 77030-4009, USA.
| |
Collapse
|
7
|
Affiliation(s)
- Sahira Farooq
- McGovern Medical School, University of Texas Health Science Center at Houston, Texas
- Correspondence to: Sahira Farooq, BS, 6431 Fannin St, MSB G.400, Houston, TX 77030.
| | - Saisindhu Narala
- Department of Dermatology, University of Texas Health Science Center at Houston, Texas
| | - Omar Pacha
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
8
|
Karri PV, Freemyer BD, Pacha O, Patel AB. Characterization of Cutaneous Adverse Events Associated With PI3K Inhibitors in 11 Patients. J Immunother Precis Oncol 2020; 3:141-146. [PMID: 35665373 DOI: 10.36401/jipo-20-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/26/2020] [Indexed: 01/02/2023]
Abstract
Introduction Phosphoinositide 3-kinase (PI3K) inhibitors are a new class of cancer therapeutics that inhibits one or more enzymes in the PI3K/AKT/mTOR tumor growth pathway. As compared to other tyrosine kinase inhibitors, there is evidence that PI3K inhibitors have a higher incidence of severe cutaneous adverse events (CAEs) ranging from 2-21%. There is a lack of further characterization of clinical trials and management options for these CAEs. Methods A retrospective chart review of our institution's records between January 2015 and May 2019 was conducted; electronic medical records were queried by using a pharmacy database and ICD-10 codes for patients receiving PI3K inhibitor who experienced CAEs during therapy. These CAEs were characterized by two board-certified dermatologists at a major cancer center. Results Eleven patients were identified as having 12 cumulative CAEs. Average time to rash onset was 4 weeks, and the most common identified rashes were eczematous (25%) and morbilliform (17%). Four patients experienced a dose delay, and one patient immediately discontinued their PI3K inhibitor. Conclusion Although most CAEs caused by PI3K inhibitors in this study were limited to grade 1-2 and were controlled with topical corticosteroids and oral antihistamines, a number of patients experienced dose impact. This highlights the dermatologist's role in managing and minimizing interruption of therapy while maintaining quality of life.
Collapse
Affiliation(s)
- Padmavathi V Karri
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Benjamin D Freemyer
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA
| | - Omar Pacha
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anisha B Patel
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Dermatology, UTHealth McGovern Medical School, Houston, TX, USA
| |
Collapse
|
9
|
Messer A, Brown AE, Pacha O, Boddu P, Geppner A, Kadia TM, Huen AO. Successful treatment of cutaneous adult T-cell leukemia/lymphoma with imiquimod. JAAD Case Rep 2019; 5:979-981. [PMID: 31709290 PMCID: PMC6835029 DOI: 10.1016/j.jdcr.2019.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alison Messer
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashley E Brown
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Omar Pacha
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajwal Boddu
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexis Geppner
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auris O Huen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
10
|
Chen WS, Tetzlaff MT, Diwan H, Jahan-Tigh R, Diab A, Nelson K, Glitza IC, Kaunitz GJ, Johnson D, Torres-Cabala C, Pacha O, Taube JM, Maloney K, Prieto VG, Curry JL. Suprabasal acantholytic dermatologic toxicities associated checkpoint inhibitor therapy: A spectrum of immune reactions from paraneoplastic pemphigus-like to Grover-like lesions. J Cutan Pathol 2018; 45:764-773. [PMID: 29943453 DOI: 10.1111/cup.13312] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/15/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Abstract
Checkpoint inhibitors (CPIs) restore the function of effector immunocytes to target and destroy cancer cells. Immune-related adverse events (irAEs) are a consequence of immune reactivation, with unpredictable inflammatory response, loss of self-tolerance, and development of autoimmunity. Adverse events from CPIs that present as dermatologic toxicities have diverse clinical and histopathologic features. CPI-associated dermatologic toxicities may exhibit histopathologic features of lichenoid dermatitis, bullous pemphigoid, and granulomatous/sarcoid-like reactions. Suprabasal acantholytic dermatologic toxicities associated with CPIs are particularly rare but represent an emerging histopathologic pattern and include lichenoid dermatitis with suprabasal acantholysis/vesicle formation to Grover disease (transient acantholytic dermatosis). Here, we report two patients who developed suprabasal acantholytic dermatologic toxicities during CPI therapy. One patient exhibited a CPI-associated autoimmune blistering disease with paraneoplastic pemphigus (PNP)-like features restricted to histopathology and immunofluorescence, while the other patient had Grover-like lesions. A review of the literature revealed a spectrum of suprabasal acantholytic dermatologic toxicities associated CPIs that may present as lichenoid dermatitis with acantholysis/vesicle formation, Grover-like eruptions, and lesions with PNP-like features restricted to histopathology and immunofluorescence. It is important for clinicians and pathologists to recognize the types of dermatologic toxicities associated with CPIs to direct appropriate therapeutic strategies.
Collapse
Affiliation(s)
- Wei-Shen Chen
- Section of Dermatopathology, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Section of Dermatopathology, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hafeez Diwan
- Department of Pathology, Baylor College of Medicine, Houston, Texas
| | - Richard Jahan-Tigh
- Department of Dermatology, University of Texas Health Science, Houston, Texas
| | - Adi Diab
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly Nelson
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Isabella C Glitza
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Genevieve J Kaunitz
- Department of Dermatology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Daniel Johnson
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Torres-Cabala
- Section of Dermatopathology, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Omar Pacha
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janis M Taube
- Department of Dermatology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
- Department of Pathology and Oncology, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Kudakwashe Maloney
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Section of Dermatopathology, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Section of Dermatopathology, Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
11
|
|
12
|
Abstract
The novelty of immune checkpoint inhibitors has only recently led to the characterization of cutaneous adverse events (AEs). This, along with the substantial rate of cutaneous reactions, has left many clinicians without sufficient familiarity to diagnose and treat. In the following chapter, we will review the categories of these drugs, common cutaneous effects, their grading, and management options.
Collapse
Affiliation(s)
- Anisha B Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1452, Houston, TX, 77030, USA.
| | - Omar Pacha
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1452, Houston, TX, 77030, USA
| |
Collapse
|
13
|
Abstract
Ecthyma gangrenosum is the cutaneous manifestation of pseudomonas infection in patients with sepsis. A previously healthy 7-month-old girl who developed ecthyma gangrenosum without apparent inciting factors became neutropenic secondary to autoimmune neutropenia 2 months after initial presentation. She was treated with appropriate surgical and medical intervention and was discharged in stable condition only to die suddenly 2 days after discharge.
Collapse
Affiliation(s)
- Omar Pacha
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas
| | | |
Collapse
|
14
|
Abstract
Photosensitivity disorders in childhood are rare, with the notable exception of overexposure as sunburn, and therefore require a more circumspect approach. Practitioners who treat children are key players in identifying and managing the many photosensitivity disorders that rarely present in childhood. A classic photodistribution of skin findings may suggest photosensitivity, but a correct diagnosis depends on a detailed history correlated with clinical findings.
Collapse
Affiliation(s)
- Omar Pacha
- Department of Dermatology, The University of Texas Medical School-Houston, 6655 Travis Street, Houston, TX 77030, USA
| | | |
Collapse
|
15
|
Gifford KA, Pacha O, Hebert AA, Nelson CL, Kirsner SM, Ballo MT, Bloom ES. A new paradigm for calculating skin dose. Brachytherapy 2013; 12:114-9. [DOI: 10.1016/j.brachy.2012.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 11/28/2022]
|
16
|
Pacha O, Kadikoy H, Amro M, Haque W, Abdellatif A. Torsades de pointes and prolonged QT syndrome in Takotsubo cardiomyopathy. J Cardiovasc Med (Hagerstown) 2012; 13:536-40. [DOI: 10.2459/jcm.0b013e328336b4a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Pacha O, Sambrano BL, Hebert AA. Skin Barrier Repair in Eczema: A Review of Current Understanding of Pathophysiology and Treatment. Curr Derm Rep 2012. [DOI: 10.1007/s13671-012-0018-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
18
|
Phillips CB, Pacha O, Biliciler-Denkta G, Hebert AA. A review of beta antagonist treatment for infantile hemangioma. J Drugs Dermatol 2012; 11:826-829. [PMID: 22777223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Infantile hemangiomas are benign vascular neoplasms of childhood that often have implications on development, cosmesis, and comfort. Traditional therapy has involved either observation or corticosteroids, depending on location and size. Recent studies have reported the successful use of beta-adrenergic antagonists in treating infantile hemangiomas. This succinct review discusses the properties and current applications of beta-adrenergic antagonists as well as the established treatments for infantile hemangioma.
Collapse
Affiliation(s)
- Carlton B Phillips
- Department of Dermatology, Division of Cardiology, University of Texas Health Science Center, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
19
|
Pacha O, Hebert AA. Treating atopic dermatitis: safety, efficacy, and patient acceptability of a ceramide hyaluronic acid emollient foam. Clin Cosmet Investig Dermatol 2012; 5:39-42. [PMID: 22690129 PMCID: PMC3363028 DOI: 10.2147/ccid.s23269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Advances in current understanding of the pathophysiology of atopic dermatitis have led to improved targeting of the structural deficiencies in atopic skin. Ceramide deficiency appears to be one of the major alterations in atopic dermatitis and the replenishment of this epidermal component through topically applied ceramide based emollients appears to be safe, well tolerated, and effective. Recently a ceramide hyaluronic acid foam has become commercially available and increasing evidence supports its safety and efficacy in patients who suffer from atopic dermatitis.
Collapse
Affiliation(s)
- Omar Pacha
- Department of Dermatology, University of Texas Health Science Center, Houston, TX, USA
| | | |
Collapse
|
20
|
Abstract
Primary hyperparathyroidism (PHPT) and multiple myeloma (MM) are frequently observed in the adult population and can each independently lead to hypercalcemia. Despite the frequency of hypercalcemia secondary to PHPT and MM, these two conditions only rarely concurrently present in patients. We describe the management of PHPT in the setting of poorly differentiated MM in a patient presenting with hypercalcemia and pancytopenia. The patient was deemed at increased risk for surgical removal of the parathyroid gland and refused surgical intervention, so we chronically managed her PHPT and hypercalcemia with Cinacalcet and bisphosphonates. All of the similar cases in the literature are reviewed in this report along with medical management of PHPT. We believe that we describe the first medically managed PHPT in the setting of MM.
Collapse
Affiliation(s)
- Zaher Fanari
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | |
Collapse
|
21
|
Haque W, Kadikoy H, Pacha O, Maliakkal J, Hoang V, Abdellatif A. Osteonecrosis secondary to antiphospholipid syndrome: a case report, review of the literature, and treatment strategy. Rheumatol Int 2009; 30:719-23. [DOI: 10.1007/s00296-009-1269-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 11/29/2009] [Indexed: 11/24/2022]
|