Cutaneous toxicities of new treatments for melanoma

Abstract

New drugs against advanced melanoma have emerged during last decade. Target therapy and immunotherapy have changed the management of patients with metastatic disease. Along with its generalized use, drug toxicities have appeared and the skin is the target organ of a significant part of them. This revision summarizes the most common side effects and consensus management to improve the compliance of therapies and patients' quality of life. Among the BRAF inhibitors, main cutaneous side effects are photosensitivity, plantar hyperkeratosis, and the appearance of verrucal keratosis or squamous cell carcinoma. Special attention must be paid to the development of new primary melanomas or changes on nevi during BRAF inhibitor therapy. The most common cutaneous side effects of immunotherapy are rash, pruritus, and vitiligo. It remains controversial the possible role of these toxicities as markers of response to therapy.

Multiple Keratoacanthoma-like Lesions in a Patient Treated with Pembrolizumab

“…Marion FRADET 1 , Vincent SIBAUD 2 , Emilie TOURNIER 3 , Laurence LAMANT 3 , Serge BOULINGUEZ 1,2 , Aurore BRUN 1 , Cecile PAGES 2 and Nicolas MEYER 1,2 Toulouse III University; IUCT-oncopole and CHU de Toulouse, 24 chemin de Pouvourville TSA 30030, FR-31059 Toulouse, 2 Department of Dermatology, IUCT-oncopole, and 4 Inserm UMR 1037-CRCT eruptive keratoacanthoma-like lesions has been reported recently in 7 patients treated with pembrolizumab, and in 5 patients treated with nivolumab (5)(6)(7)(8)(9)(10). Similar to the present case, eruptive keratoacanthoma-like lesions induced by immunotherapy are reported to appear early, between 2 and 18 months after the first infusion.…”

“…The anti-tumour efficacy of anti-programmed cell death (anti-PD1) therapy has been demonstrated in a large range of malignant neoplasms, including metastatic melanoma, advanced cutaneous squamous cell carcinoma and lung carcinoma (1). Despite presenting a favour able safety profile, monoclonal antibodies targeting PD-1 are associated with dermatological toxicities, which affect approximately > 30% of treated patients (2). These predominantly manifest as eczema-like maculopapular rashes, lichenoid reactions, vitiligo-like lesions, or flares of psoriasis.…”

LncRNA SNHG5 promotes growth and invasion in melanoma by regulating the miR-26a-5p/TRPC3 pathway

“…Melanoma is prone to metastasis, resulting in an unfavorable prognosis of patients in distant stage, with a 5-year survival rate of only 18% 2. Although immune-based approaches and chemoprevention have improved the management of metastatic disease, drug toxicity and resistance are still major challenges 3,4. Thus, elucidating the mechanisms underlying melanoma progression and identifying novel therapeutic targets are of great significance.…”

Monoclonal Antibodies in Dermatooncology—State of the Art and Future Perspectives

“…While both these populations suffer from colitis, endocrinopathies and cutaneous toxicity, pneumonitis and nephritis are typical for the group treated with anti-PD-1/PD-L1 [259]. Skin toxicities following immune checkpoint inhibition in melanoma have been thoroughly reviewed in [265] and are mostly observed in ipilimumab-treated patients. Skin-related side effects, experienced by around 60% of patients, are rarely severe and are mostly limited to rash and itching occurring at the beginning of the treatment, with its peak at the sixth week [266].…”