Bullous pemphigoid in a patient treated with nivolumab

Cuenca‐Barrales, Carlos; Espadafor-López, Beatriz; Martínez-López, Antonio; Cancela-Díez, Bárbara; Ruiz‐Villaverde, Ricardo

doi:10.1111/dth.13030

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…Reference lists of the 139 eligible articles were also screened for additional articles, and 77 articles met the eligibility criteria after screening. Among these, 70 articles reporting clinical data from 127 individual patients were reviewed to include in the analytic component of the systematic review. The 7 other articles provided predominantly summarized data, with limited and inconsistent data from individual patients.…”

Section: Resultsmentioning

confidence: 99%

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

et al. 2022

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IMPORTANCEThere is limited information on immune checkpoint inhibitor-induced bullous pemphigoid (ICI-BP) in patients with cancer, with most existing studies being case reports or small case series from a single institution. Prior review attempts have not approached the literature in a systematic manner and have focused only on ICI-BP secondary to anti-programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) therapy. The current knowledge base of all aspects of ICI-BP is limited.OBJECTIVE To characterize the risk factors, clinical presentation, diagnostic findings, treatments, and outcomes of ICI-BP in patients with cancer as reported in the current literature.EVIDENCE REVIEW A systematic review was performed using PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Articles reporting data on individual patients who met preestablished inclusion criteria were selected, and a predefined set of data was abstracted. When possible, study results were quantitatively combined.FINDINGS In total, 70 studies reporting data on 127 individual patients undergoing ICI therapy for cancer (median [IQR] age, 71 [64-77] years; 27 women [21.3%]) were included. In pooled analyses, patients ranged in age from 35 to 90 years. Immune checkpoint inhibitor-induced bullous pemphigoid often occurred during the course of anti-PD-1, PD-L1, or cytotoxic T lymphocyte-associated antigen 4 therapy but was also found to develop up to several months after treatment cessation. Prodromal symptoms, such as pruritus or nonspecific skin eruptions, were found in approximately half of the patient population. Histopathologic or serologic testing, when undertaken, was a helpful adjunct in establishing diagnosis. Treatment with immunotherapy was discontinued after ICI-BP development in most patients. The most common treatments were systemic and topical corticosteroids. Steroid-sparing therapies, such as antibiotics and other systemic immunomodulators, were also used as adjuvant treatment modalities. Biologic and targeted agents, used predominantly in cases refractory to treatment with corticosteroids, were associated with marked symptomatic improvement in most patients. CONCLUSIONS AND RELEVANCEThe results of this systematic review suggest that ICI-BP often poses a therapeutic challenge for patients with cancer who are receiving immunotherapy. Further research on the early recognition, diagnosis, and use of targeted treatment modalities will be essential in developing more personalized treatment options for affected patients while minimizing morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

et al. 2022

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“…Our case overlapped with the presentation of bullous pemphigoid and initiation of nivolumab occurring eleven months after initiation. One proposed reason why bullous pemphigoid occurs months after initiation of nivolumab is the long average life of PD-1 inhibitors and the persistence of immune response with these agents [ 9 ]. The reported average half-life of nivolumab is approximately twenty-seven days with a steady-state of twelve weeks [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…From the MEDLINE search of PubMed, it is worth noting that most of the case reports and case series detailed bullous pemphigoid occurring while receiving nivolumab [ 3 , 5 , 6 ]. Three separate articles detail the development of bullous pemphigoid after discontinuation of nivolumab [ 3 , 9 , 11 ]. Our case fits into the latter category of developing bullous pemphigoid following discontinuation of nivolumab.…”

Section: Discussionmentioning

confidence: 99%

A Case of Bullous Pemphigoid Associated With Nivolumab Therapy

Gotera¹,

Weilg²,

Heleno³

et al. 2022

Cureus

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This is a case report of new-onset bullous pemphigoid after the initiation of nivolumab for melanoma. Bullous pemphigoid is a rare immune-mediated adverse effect of nivolumab, with fewer than a hundred cases described. The patient initially developed a rash, which later progressed to respiratory symptoms, prompting the discontinuation of nivolumab. He was started on oral steroids, which improved his symptoms. However, while being tapered off the steroids, his rash reoccurred with the development of bullous pemphigoid. The diagnosis was confirmed by increased eosinophils and sub-epidermal vesicle formation compatible with bullous pemphigoid on skin biopsy. The patient was treated with steroids, mycophenolate, doxycycline, and niacinamide with significant improvement in his symptoms.

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“…Previous evidence showed that the median number of weeks of immunotherapy prior to onset of BP was 17 (range of 3 to 91) [7] . However, delayed cases have been reported, even several months after discontinuation of immunotherapy [8,9] .…”

Section: Discussionmentioning

confidence: 99%

Nivolumab-induced severe bullous pemphigoid in a patient with renal cancer: a case report and literature review

Wu¹,

Palvai²,

Jalil³

2020

JCMT

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With the widespread use of immunotherapy in numerous solid tumours, immunotherapy-related adverse events (irAEs) have started to emerge and bring new challenges for clinicians to manage. Among established irAEs, dermatologic toxicity is one of the most common toxicities; it is often mild but can be severe and potentially life-threatening, such as bullous pemphigoid. Here, we report a case of nivolumab-mediated severe, extensive, refractory bullous pemphigoid involving both skin and oral mucosa in a patient with metastatic renal cancer. We also summarise a list of selected case reports of immunotherapy-induced bullous pemphigoid by literature review. We highlight various presentations, investigations and managements of this type of skin irAEs. Meantime, we would like to discuss the correlation of skin irAEs incidence rate with immunotherapy drug benefit and resistance.

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Bullous pemphigoid in a patient treated with nivolumab

Cited by 8 publications

References 10 publications

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

A Case of Bullous Pemphigoid Associated With Nivolumab Therapy

Nivolumab-induced severe bullous pemphigoid in a patient with renal cancer: a case report and literature review

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