Lupus‐like cutaneous reaction following pembrolizumab: An immune‐related adverse event associated with anti‐PD‐1 therapy

Abstract

PD-1 (programmed cell death-1) inhibitors, used to treat metastatic melanoma and other malignancies, are associated with development of immune-related adverse events in the skin. Such reactions include morbilliform eruptions, vitiligo, alopecia areata and bullous pemphigoid. In this report, we describe a patient who developed a lupus-like cutaneous reaction in the setting of pembrolizumab therapy for metastatic melanoma, adding to the spectrum of reactions which may be observed in association with PD-1 inhibitor therapy. showed a slight increase in mucinous ground substance. These features were interpreted as a lupus-like medication reaction. Based on these findings, pembrolizumab continued to be withheld in the patient. Within 1 month, the rash completely resolved without use of

Panniculitis in a patient with pathologic complete response to talimogene laherparepvec treatment for recurrent, in‐transit melanoma

“…A lupus-like cutaneous reaction has been reported following pembrolizumab therapy. 31 Unlike our case, the reported patient presented with erythematous and nonpruritic edematous papules coalescing into plaques on the back, chest, arms, thighs, and abdomen 2.5 months after discontinuing therapy. Panniculitis was not noted.…”

Drug-induced lupus erythematosus following immunotherapy with anti-programmed death-(ligand) 1

“…This report is the first series of cases of lupus erythematosus induced by anti-PD(L)1 immunotherapy. A recent similar case report of pembrolizumab-related subacute cutaneous lupus erythematosus was provided 5. The DI-LE has been variously reported after drug exposure such as hydralazine, procainamide, quinidine, oestrogen, tumour necrosis factor inhibitors, chlorpromazine, isoniazid, practolol, penicillamine and minocycline 6.…”

Pembrolizumab‐induced sarcoidal infusion site reaction

“…Adverse cutaneous reactions to PD‐1 inhibitors have been reported in up to 21%‐49% of patients receiving therapy . These adverse cutaneous eruptions have included eczematous eruptions, lichenoid reactions, vitiligo, morbilliform eruption, alopecia areata, bullous pemphigoid and lupus‐like reactions …”

“…While adverse cutaneous reactions to PD‐1 inhibitors typically occur within the first 3 months of therapy, prior reports have described reactions taking place months after the final therapy dose . This highlights the fact that the effects of immunomodulatory treatments can be seen well beyond the scope of their anticipated pharmacokinetic profile . Additionally, because PD‐1 inhibitors function by honing an individual's immunity against a cancer, this mechanism raises the question of whether PD‐1 inhibitors as a class might increase the risk of exacerbating an underlying autoimmune illness or unmasking the development of a new one, such as bullous pemphigoid, cutaneous lupus erythematosus or sarcoidosis …”

“…3,4 These adverse cutaneous eruptions have included eczematous eruptions, lichenoid reactions, vitiligo, morbilliform eruption, alopecia areata, bullous pemphigoid and lupus-like reactions. [3][4][5] Granulomatous sarcoidosis-like processes affecting the lungs, lymph nodes, and skin have previously been reported in patients receiving PD-1 inhibitor therapy, both with pembrolizumab and nivolumab. [6][7][8][9] Cutaneous sarcoidal reactions have also been described following treatment with ipilimumab, an inhibitor of cytotoxic T-lymphocyte-associated antigen.…”