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Review
. 2022 Jun 1;61(11):1735-1738.
doi: 10.2169/internalmedicine.7472-21. Epub 2021 Nov 20.

Severe Skin Toxicity Caused by Sequential Anti-PD-1 Antibody and Alectinib in Non-small-cell Lung Cancer: A Report of Two Cases and a Literature Review

Akihiro Nishiyama  1   2 , Yoshihiro Hattori  3 , Shinji Takeuchi  1   2 , Azusa Tanimoto  1   2 , Miyako Satouchi  3 , Toshinori Murayama  4 , Seiji Yano  1   2
Affiliations
Review

Severe Skin Toxicity Caused by Sequential Anti-PD-1 Antibody and Alectinib in Non-small-cell Lung Cancer: A Report of Two Cases and a Literature Review

Akihiro Nishiyama et al. Intern Med. .

Abstract

Immune checkpoint inhibitors (ICIs) have demonstrated marked efficacy in some cancer patients, but they may cause various severe immune-related adverse events. Alectinib is a second-generation anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitor (TKI) approved for ALK-rearranged non-small-cell lung cancer (NSCLC). Alectinib is said to be safer than other TKIs. We conducted an investigator-initiated trial of alectinib, which also has RET kinase-inhibitory activity, against RET-rearranged NSCLC. Two RET-rearranged NSCLC patients experienced severe skin toxicity with alectinib after first undergoing anti-PD-1 antibody treatment with an ICI. These findings suggest that we should carefully follow patients for adverse effects of targeted drugs following ICI treatment.

Keywords: ICIs; alectinib; anti-PD-1 antibody; severe skin toxicity.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
a: Skin rash observed in case 1. A woman in her 40s. Alectinib 600 mg twice daily was started 24 days after the final administration of nivolumab. Picture shows erythema multiforme on day 13. b: Close-up picture of (a).
Figure 2.
Figure 2.
Skin rash observed in Case 2. A woman in her 30s. Alectinib 600 mg twice daily was started eight weeks after the final administration of nivolumab. Picture shows erythema multiforme on day 12.
See this image and copyright information in PMC

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