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. 2022 Mar;86(3):563-572.
doi: 10.1016/j.jaad.2021.03.094. Epub 2021 Apr 2.

Epidemiology and risk factors for the development of cutaneous toxicities in patients treated with immune-checkpoint inhibitors: A United States population-level analysis

Shannon Wongvibulsin  1 , Vartan Pahalyants  2 , Mark Kalinich  3 , William Murphy  2 , Kun-Hsing Yu  4 , Feicheng Wang  5 , Steven T Chen  6 , Kerry Reynolds  7 , Shawn G Kwatra  8 , Yevgeniy R Semenov  9
Affiliations

Epidemiology and risk factors for the development of cutaneous toxicities in patients treated with immune-checkpoint inhibitors: A United States population-level analysis

Shannon Wongvibulsin et al. J Am Acad Dermatol. 2022 Mar.

Abstract

Background: A variety of dermatoses have been reported in the growing number of patients treated with immune-checkpoint inhibitors (ICIs), but the current understanding of cutaneous immune-related adverse events (irAEs) is limited.

Objective: To determine the cumulative incidence, distribution, and risk factors of cutaneous irAEs after ICI initiation.

Methods: This was a retrospective cohort study of patients in a national insurance claims database including cancer patients treated with ICIs and matched controls.

Results: The study included 8637 ICI patients and 8637 matched controls. The overall incidence of cutaneous irAEs was 25.1%, with a median onset time of 113 days. The ICI group had a significantly higher incidence of pruritus, mucositis, erythroderma, maculopapular eruption, vitiligo, lichen planus, bullous pemphigoid, Grover disease, rash, other nonspecific eruptions, and drug eruption or other nonspecific drug reaction. Patients with melanoma and renal cell carcinoma and those receiving combination therapy were at a higher risk of cutaneous irAEs.

Limitations: Retrospective design without access to patient chart data.

Conclusions: This study identifies cutaneous irAEs in a real-world clinical setting and highlights patient groups that are particularly at risk. The results can aid dermatologists at the bedside in the diagnosis of cutaneous irAEs and in formulating management recommendations to referring oncologists regarding the continuation of ICI therapy.

Keywords: Cutaneous; dermatologic; drug reactions; immune-checkpoint inhibitors; immune-related adverse events; immunotherapy.

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Conflict of interest statement

Conflicts of interest None disclosed.

Figures

Fig 1.
Fig 1.
Study flow diagram.
Fig 2.
Fig 2.
Cutaneous immune-related adverse events. Incidence rate ratios for cutaneous diagnoses previously reported as immune-related adverse events for immune-checkpoint inhibitor group compared to the control group.
See this image and copyright information in PMC

References

    1. Schadendorf D, Hodi FS, Robert C, et al. Pooled analysis of long-term survival data from phase II and phase III trials of ipilimumab in unresectable or metastatic melanoma. J Clin Oncol. 2015;33(17):1889–1894. - PMC - PubMed
    1. Gong J, Chehrazi-Raffle A, Reddi S, Salgia R. Development of PD-1 and PD-L1 inhibitors as a form of cancer immunotherapy: a comprehensive review of registration trials and future considerations. J Immunother Cancer. 2018;6(1):1–18. - PMC - PubMed
    1. Geisler A, Phillips G, Barrios D, et al. CME Part II: immune checkpoint inhibitor-related dermatologic adverse events. J Am Acad Dermatol. 2020;83(5):1255–1268. - PMC - PubMed
    1. Hassel JC, Heinzerling L, Aberle J, et al. Combined immune checkpoint blockade (anti-PD-1/anti-CTLA-4): evaluation and management of adverse drug reactions. Cancer Treat Rev. 2017;57:36–49. - PubMed
    1. Haslam A, Prasad V. Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs. JAMA Netw Open. 2019;2(5):e192535. - PMC - PubMed

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