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. 2016 Apr 19:4:20.
doi: 10.1186/s40425-016-0123-3. eCollection 2016.

Disease stabilization with pembrolizumab for metastatic acral melanoma in the setting of autoimmune bullous pemphigoid

Kristen M Beck #  1   2 , Joanna Dong #  3 , Larisa J Geskin  2 , Vincent P Beltrani  2 , Richard G Phelps  3   4 , Richard D Carvajal  1 , Gary Schwartz  1 , Yvonne M Saenger  1 , Robyn D Gartrell  1
Affiliations

Disease stabilization with pembrolizumab for metastatic acral melanoma in the setting of autoimmune bullous pemphigoid

Kristen M Beck et al. J Immunother Cancer. .

Abstract

Background: To date, patients with pre-existing autoimmune conditions have been excluded from immunotherapy trials out of concern for severe autoimmune exacerbations.

Case presentation: We describe the first case of a patient with metastatic cKIT mutated acral melanoma, brain metastasis, and pre-existing severe autoimmune bullous pemphigoid (BP) with stable and asymptomatic disease 10 months after treatment with pembrolizumab. The patient experienced severe BP exacerbation after therapy with ipilimumab requiring systemic immune suppression, but nonetheless pembrolizumab was administered on further disease progression.

Conclusions: This case suggests that pembrolizumab may confer more benefit than risk even in patients with known severe autoimmune conditions who require intermittent systemic immunosuppression.

Keywords: Anti-PD1; Autoimmunity; Bullous pemphigoid; Immune-related adverse events [irAEs]; Immunotherapy; Metastatic Melanoma; Pembrolizumab.

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Figures

Fig. 1
Fig. 1
Biopsy of the patient’s skin lesions. Haematoxylin and eosin stain reveals subepidermal bulla as well as fibrin net, numerous eosinophils, perivascular mixed infiltrate, and well-preserved dermal papillae within the bulla cavity
Fig. 2
Fig. 2
Cutaneous melanoma lesion with surrounding vitiligo
Fig. 3
Fig. 3
Clinical picture of ruptured bullae, erosions, and crusts of mild bullous pemphigoid exacerbation on low-dose corticosteroid treatment
See this image and copyright information in PMC

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