Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe dermatological toxicities from checkpoint inhibitors

Abstract

Immune checkpoint inhibitors (ICIs) frequently result in cutaneous immune-related adverse events (IrAEs). Although the majority of these events are mild-to-moderate in severity, up to 5% are severe, which may lead to morbidity and dose interruption or discontinuation of ICI therapy. In addition, up to 25% of dermatologic IrAEs are corticosteroid-refractory or corticosteroid-dependent. These 2020 MASCC recommendations cover the diagnosis and management of cutaneous IrAEs with a focus on moderate-to-severe and corticosteroid-resistant events. Although the usage of immune-suppressive therapy has been advocated in this setting, there is a lack of randomized clinical trial data to provide a compelling level of evidence of its therapeutic benefit.

Keywords: Bullous dermatoses; Corticosteroids; Cutaneous IrAEs; Inflammatory dermatitis; Pruritus; Skin rash; Vitiligo.

Figure 1:

Clinical phenotype of dermatologic Immune-Related Adverse Events (IrAEs): Maculopapular rash (left upper); Lichenoid rash (right upper); Eczematous (left lower); Bullous Pemphigoid (right lower).

Figure 2:. Management of Dermatologic Immune-Related Adverse Events

MTX, methotrexate; CsA, cyclosporine A; MMF, Mycophenolate Mofetil; MPR, maculopapular rash; IL-6, interleukin-6; IgE immunoglobulin E.