Eosinophilic fasciitis and lichen sclerosus in a patient treated with nivolumab

Andrés-Lencina, Juan-José; Burillo-Martínez, Sara; Aragón‐Miguel, Raquel; Calleja‐Algarra, Alba; Rodríguez-Peralto, J.L.; Ortiz-Romero, Pablo-Luis; Gargallo-Moneva, Vanessa

doi:10.1111/ajd.12836

Cited by 18 publications

(11 citation statements)

References 7 publications

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“…Increased AEC, serum IL-6, Il-10 and IgE levels were associated with corticosteroid-refractory adverse events and with grade 3 or greater cutaneous AEs, but the direct accountability of eosinophils was not assessed in these exceptional cases. 24 Even if some severe cutaneous AEs like drug reaction with eosinophilia and systemic symptoms (DRESS) require high-dose corticosteroids, 25,26 multiple recent reports of Eo-irAEs like eosinophilic fasciitis [27][28][29][30] or eosinophilic granulomatosis with polyangiitis 31 suggest that topical or low-dose oral corticosteroids, with or without CSsparing treatments, can give excellent results. Taking account these data, and given that in our work (i) Eo-ir and Eo-irAEs accounted for half of all ICI discontinuations and (ii) no deaths were directly attributable to eosinophil-organ damage, we suggest that the initiation of corticosteroids and the maintenance of the ICI might be an effective therapeutic strategy in patients with moderate-to-severe eosinophilia and whose cancer is under control.…”

Section: Discussionmentioning

confidence: 99%

Moderate-to-severe eosinophilia induced by treatment with immune checkpoint inhibitors: 37 cases from a national reference center for hypereosinophilic syndromes and the French pharmacovigilance database

et al. 2020

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A better understanding of immune-related adverse events is essential for the early detection and appropriate management of these phenomena. We conducted an observational study of cases recorded at the French reference center for hypereosinophilic syndromes and in the French national pharmacovigilance database. Thirty-seven reports of eosinophilia induced by treatment with immune checkpoint inhibitors (ICIs) were included. The median [range] time to the absolute eosinophil count (AEC) peak was 15 [4─139] weeks. The median AEC was 2.7 [0.8─90.9] G/L. Eosinophil-related manifestations were reported in 21 of the 37 cases (57%). If administered, corticosteroids were always effective (n = 10 out of 10). Partial or complete remission of eosinophilia was obtained in some patients not treated with corticosteroids, after discontinuation (n = 12) or with continuation (n = 4) of the ICI. The AEC should be monitored in ICI-treated patients. If required by oncologic indications, continuation of ICI may be an option in asymptomatic hypereosinophilic patients, and in corticosteroid responders.

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Section: Discussionmentioning

confidence: 99%

Moderate-to-severe eosinophilia induced by treatment with immune checkpoint inhibitors: 37 cases from a national reference center for hypereosinophilic syndromes and the French pharmacovigilance database

et al. 2020

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“…There are 11 reported cases of fasciitis resulting from CPI therapy, although they are variably labeled: 5 are described as “eosinophilic fasciitis,” 1 “lymphocytic fasciitis,” with only mild eosinophilia and without an eosinophilic infiltrate within the fascia on biopsy , 4 “myofasciitis” (fasciitis with muscle involvement) , and 1 “asymptomatic fasciitis.” .…”

Section: Data Reviewmentioning

confidence: 99%

Eosinophilic Fasciitis Following Checkpoint Inhibitor Therapy: Four Cases and a Review of Literature

et al. 2019

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Background. Checkpoint inhibitor therapy is widely known to cause a number of immune-related adverse events. One rare adverse effect that is emerging is eosinophilic fasciitis, a fibrosing disorder causing inflammatory infiltration of subcutaneous fascia. It is characterized clinically by edema and subsequent induration and tightening of the skin and subcutaneous tissues. The condition is rare, yet at our institutions we have seen four cases in the past 3 years. We describe our 4 cases and review 11 other cases reported in the literature. Case Presentation. We present four cases of eosinophilic fasciitis following treatment with programmed cell death protein 1 or programmed cell death-ligand 1 blockade. All patients had extremity involvement with characteristic skin changes ranging from peripheral edema to induration, tightening, and joint limitation. The patients had varying degrees of peripheral eosinophilia. In two of our patients, the diagnosis was made by full-thickness skin biopsy showing lymphocytic infiltration of the subcutaneous fascia, with CD4+ T cells predominating in one case and CD8+ T cells in the other. In the other two cases, the diagnosis was made on the basis of characteristic imaging findings in the context of clinical features consistent with the diagnosis. All four patients were treated with glucocorticoids with varying degrees of success; immunotherapy had to be discontinued in all four. Patients with advanced melanoma who experienced this adverse effect had either a partial response or a complete response to therapy. Conclusion. Eosinophilic fasciitis can occur as a result of checkpoint inhibitor therapy. Although a tissue diagnosis is the gold standard, imaging studies may facilitate the diagnosis in the presence of consistent clinical features, but a degree of suspicion is key to recognizing the condition early. Therapy requires a collaborative approach by oncology, rheumatology, and dermatology; physical therapy is an important adjunct in treatment. For advanced melanoma, it may be a good prognostic indicator. The Oncologist 2020;25:140-149 Implications for Practice: It is important for clinicians to recognize that eosinophilic fasciitis is a potential immune-related adverse event (irAE) as a consequence of immune checkpoint inhibitor therapy. The presentation is quite stereotypical; the diagnosis can be made by imaging in the absence of a full-thickness skin biopsy. Early intervention is important to limit morbidity. This irAE may be a good prognostic sign among patients with melanoma.

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“… 5 To our knowledge, there are 10 reported cases of EF from ICI therapy in the literature. 4 , 5 , 6 , 7 , 8 , 9 , 10 Among these 10 cases, the median age was 55 years (range, 43-77), 5 were females, median onset was 11 months (3-22) after initiation of ICI therapy, and 8 of 9 (89%) had peripheral eosinophilia. Immunotherapy included atezolizumab, nivolumab, pembrolizumab, or nivolumab and ipilimumab combination therapy.…”

Section: Discussionmentioning

confidence: 99%

“… 3 More recently, there are reports of EF in patients on anti–programmed death-1 or anti–programmed death ligand-1 therapy, usually requiring treatment interruption and systemic immunosuppression. 4 , 5 , 6 , 7 , 8 , 9 , 10 We present a case of new-onset EF during nivolumab therapy managed without treatment interruption or systemic immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic fasciitis induced by nivolumab therapy managed without treatment interruption or systemic immunosuppression

et al. 2020

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Eosinophilic fasciitis and lichen sclerosus in a patient treated with nivolumab

Cited by 18 publications

References 7 publications

Moderate-to-severe eosinophilia induced by treatment with immune checkpoint inhibitors: 37 cases from a national reference center for hypereosinophilic syndromes and the French pharmacovigilance database

Moderate-to-severe eosinophilia induced by treatment with immune checkpoint inhibitors: 37 cases from a national reference center for hypereosinophilic syndromes and the French pharmacovigilance database

Eosinophilic Fasciitis Following Checkpoint Inhibitor Therapy: Four Cases and a Review of Literature

Eosinophilic fasciitis induced by nivolumab therapy managed without treatment interruption or systemic immunosuppression

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