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Ingen-Housz-Oro S, Milpied B, Bensaid B, Elshot Y, Brüggen MC, Starace M, Kaffenberger BH, Carrera C, Pham-Ledard A, Freites-Martinez A, Sanchez-Pena P, Lebrun-Vignes B, French LE, Sibaud V. Drug reactions with eosinophilia and systemic symptoms induced by immune checkpoint inhibitors: an international cohort of 13 cases. Melanoma Res 2023; 33:155-158. [PMID: 36749114 DOI: 10.1097/cmr.0000000000000877] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Among dermatologic adverse events induced by immune checkpoint inhibitors (ICI), drug reactions with eosinophilia and systemic symptoms (DRESS) have been very rarely reported. The objective of this study is to better define the clinical and histologic features, treatment and prognosis of ICI-related DRESS. This retrospective case series was conducted between 01 January 2015 and 31 December 2021 by the dermatology departments of five international networks involved in drug reactions. Inclusion criteria were age ≥18 years old, DRESS with Regiscar score ≥4 (probable or certain) and ICI as a suspect drug. Clinical, biologic and follow-up data were extracted from the medical charts. Thirteen patients were included. The median time to onset was 22 days (3-11). No patients had a high-risk drug introduced in the past 3 months. A majority of patients presented fever (92%), diffuse exanthema (77%) and facial edema (69%). Biologic features included hypereosinophilia in eight patients (61.5%), hyperlymphocytosis in 3 (23%), elevated liver function tests in 11 (85%, grade 1 or 2 in most cases) and renal involvement in 5 (38%). Two patients (15%) had lung involvement. PCR evidence of viral replication was detected in five patients (38.5%). Treatment involved discontinuation of the suspect ICI and systemic steroids with variable dose and duration regimens. Among the four patients in which ipilimumab + nivolumab combination therapy was initially suspected, one was rechallenged with nivolumab monotherapy with good tolerance. Five patients were switched to another anti-PD-1 plus low-dose systemic steroids, with good tolerance in four cases. No patient died because of DRESS. DRESS induced by ICI are rare and of moderate severity. A consensus for management is still pending.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- University Paris est Créteil EpidermE, Créteil, France
- EADV European Task Force 'Dermatology for cancer patients'
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
| | - Brigitte Milpied
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- EADV European Task Force 'Dermatology for cancer patients'
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Dermatology Department, CHU Bordeaux, Bordeaux
| | - Benoit Bensaid
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Dermatology Department, CHU Edouard Herriot, Lyon, France
| | - Yannick Elshot
- EADV European Task Force 'Dermatology for cancer patients'
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie Charlotte Brüggen
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Department of Dermatology, University Hospital Zurich
- Faculty of Medicine, University Zurich, Zurich
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Michela Starace
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology -IRCCS Policlinico di Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna, Italy
| | - Benjamin H Kaffenberger
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology Department, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cristina Carrera
- EADV European Task Force 'Dermatology for cancer patients'
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, Barcelona
- CIBERER Centro de investigaciones Biomedicas en Red de Enfermedades Raras Insituto de Salud Carlos III
- Pharmacovigilance Technical Committee Hospital Clinic Barcelona
| | | | - Azael Freites-Martinez
- EADV European Task Force 'Dermatology for cancer patients'
- Oncodermatology Clinic, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
| | - Paola Sanchez-Pena
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- Pharmacovigilance Department, CHU Bordeaux, Bordeaux
| | - Bénédicte Lebrun-Vignes
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil
- FISARD group, Paris
- Pharmacovigilance Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Lars E French
- ToxiTEN group, European Reference Network for Rare Skin Diseases, Paris
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilan University (LMU) Munich, Munich, Germany
- Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vincent Sibaud
- EADV European Task Force 'Dermatology for cancer patients'
- Department of Oncodermatology, Claudius Regaud Institute and University Cancer Institute Toulouse Oncopole, Toulouse, France
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Kadouch DJ, Wolkerstorfer A, Elshot Y, Zupan-Kajcovski B, Crijns MB, Starink MV, Bekkenk MW, van der Wal AC, Spuls PI, de Rie MA. Treatment of Basal Cell Carcinoma Using a One-Stop-Shop With Reflectance Confocal Microscopy: Study Design and Protocol of a Randomized Controlled Multicenter Trial. JMIR Res Protoc 2015; 4:e109. [PMID: 26362616 PMCID: PMC4704900 DOI: 10.2196/resprot.4303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/30/2015] [Revised: 04/03/2015] [Accepted: 04/30/2015] [Indexed: 11/19/2022] Open
Abstract
Background Basal cell carcinoma (BCC) is the most common cancer diagnosed in white populations worldwide. The rising incidence of BCC is becoming a major worldwide public health problem. Therefore, there is a need for more efficient management. Objective The aim of this research is to assess the efficacy and safety of a one-stop-shop (OSS) concept, using real-time in vivo reflectance confocal microscopy (RCM) (Vivascope 1500; Lucid Technologies, Henrietta, NY, USA) as a diagnostic tool, prior to surgical management of new primary BCCs. Methods This is a prospective non-inferiority multi-center RCT designed to compare the “OSS concept using RCM” to current standards of care in diagnosing and treating clinically suspected BCC. Patients ≥ 18 years attending our outpatient clinic at the Department of Dermatology, Academic Medical Center, University of Amsterdam, and the Department of Dermatology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (Amsterdam, The Netherlands) with a clinically suspected new primary BCC lesion will be considered for enrollment using predefined inclusion and exclusion criteria, and will be randomly allocated to the experimental or control group. The main outcome parameter is the assessment of incomplete surgical excision margins on the final pathology report of confirmed BCC lesions (either by punch biopsy or RCM imaging). Other outcome measures include diagnostic accuracy (sensitivity and specificity) of RCM for diagnosing BCC and dividing between subtypes, and throughput time. Patient satisfaction data will be collected postoperatively after 3 months during routine follow-up. Results This research is investigator-initiated and received ethics approval. Patient recruitment started in February 2015, and we expect all study-related activities to be completed by fall 2015. Conclusions This RCT is the first to examine an OSS concept using RCM for diagnosing and treating clinically suspected BCC lesions. Results of this research are expected to have applications in evidence-based practice for the increasing number of patients suffering from BCC and possibly lead to a more efficient disease management strategy. Trial Registration ClinicalTrials.gov: NCT02285790; https://clinicaltrial.gov/ct2/show/NCT02285790 (Archived by WebCite at http://www.webcitation.org/6b2LfDKWu).
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Affiliation(s)
- Daniel J Kadouch
- Academic Medical Center, Department of Dermatology, University of Amsterdam, Amsterdam, Netherlands.
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