Pembrolizumab associated Stevens–Johnson syndrome with porokeratosis in a patient in the setting of primary hepatocellular carcinoma

Zhang, Jing; Zhang, Peng; Xu, Qiuyun; Zhu, Yangjun; Chen, Wen; Ji, Chao

doi:10.1111/ajd.13704

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…In total, 95 cases of ICI‐induced SJS/TEN were identified from 55 peer‐reviewed publications, with 35 cases of SJS, two cases of SJS/TEN overlap, and 26 cases of TEN 7–63 (Figure 1a and Supporting Information Table S1). The precise nomination of the remaining 32 cases as SJS, SJS/TEN overlap or TEN was not specified by authors of the above publications.…”

Section: Resultsmentioning

confidence: 99%

“…The duration from onset of SJS/TEN to death was most frequent under 2 weeks (35.7%), with death occurring within 1 week in 21.4% of cases (three out of 14 cases) (Figure 3D). 16,51,62 The most common causes of death in the context of ongoing SJS/TEN were cancer progression, sepsis, and multiple organ failure (Figure 3e). There was no apparent difference in mortality rates when comparing different treatment methods and types of supportive care, except in the case of corticosteroid monotherapy, where a trend of a lower mortality rate compared to other treatments was observed (Figure 3f).…”

Section: Mucosal Involvement Is Very Common In Classical Sjs/ten Oc-mentioning

confidence: 99%

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Immune checkpoint inhibitor‐induced epidermal necrolysis: A narrative review evaluating demographics, clinical features, and culprit medications

Satoh,

Neulinger,

Stadler

et al. 2023

The Journal of Dermatology

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Immune checkpoint inhibitors (ICIs) have transformed cancer treatment but can cause immune‐related adverse events (irAEs). Severe cutaneous irAEs, including epidermal necrolysis, are rare but potentially life‐threatening. There is limited understanding of the clinical features and management of ICI‐induced Stevens‐Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), so we aimed to analyze 95 cases of ICI‐induced SJS/TEN (35 cases of SJS, 26 cases of TEN, two cases of SJS/TEN overlap, and 32 cases of unspecified) to increase knowledge of this condition among oncologists and dermatologists. We conducted a comprehensive search of PubMed for all relevant case reports published until the end of December 2022, and collected data on patient demographics, cancer type, ICI regimen, time to onset of SJS/TEN, clinical presentation, management strategies, and outcomes. PD‐1 inhibitors were the most common ICIs associated with SJS/TEN (58.9%), followed by the combination of PD‐1 and CTLA‐4 inhibitors (11.6%), and PD‐L1 inhibitors (6.3%). Lung cancer and melanoma were the most frequent malignancies treated (35.8% and 25.4%, respectively). SJS/TEN occurred most frequently within the first 4 weeks (51.7%), and corticosteroid monotherapy was the most commonly chosen systemic treatment (56.4%). The overall mortality rate of ICI‐induced SJS/TEN was 30.8%. Our findings highlight the frequency and severity of ICI‐induced SJS/TEN and the urgent need for predictive molecular biomarkers aimed at preventive measures and early intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Mucosal Involvement Is Very Common In Classical Sjs/ten Oc-mentioning

confidence: 99%

Immune checkpoint inhibitor‐induced epidermal necrolysis: A narrative review evaluating demographics, clinical features, and culprit medications

Satoh,

Neulinger,

Stadler

et al. 2023

The Journal of Dermatology

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“…The progress made in cancer detection and the evolution of anticancer drug therapy have contributed to a rising occurrence of cutaneous adverse reactions following the administration of anticancer medications. 20 Patients afflicted with malignancies commonly present with concurrent comorbidities, multi-systemic involvement, and are subjected to multiple concomitant medications and treatment modalities. 21 , 22 These factors collectively contribute to the heightened intricacies and challenges encountered in the management of SJS and TEN within the context of cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Emerging Insights into Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Immune Checkpoint Inhibitor and Tumor-Targeted Therapy

Lin,

Gong,

Ruan

et al. 2024

JIR

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Objective Anticancer drugs have revolutionized tumor therapy, with cutaneous toxicities such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) being common immune-related adverse events. The debate over the efficacy of systemic corticosteroids in treating these conditions persists, while tumor necrosis factor (TNF)-alpha inhibitors show promise. This study aims to evaluate the effectiveness and safety of combination therapy involving the TNF-α inhibitor adalimumab for SJS/TEN induced by anticancer drugs. Methods A literature review of SJS/TEN cases induced by anticancer drugs from 1992 to 2023 was conducted, alongside an analysis of patients admitted to the First Affiliated Hospital of Fujian Medical University during the same period. Clinical characteristics, skin healing time, mortality, and adverse events were evaluated in two treatment groups: SJS/TEN patients treated with targeted anticancer therapies and immunotherapies. Results Among the 27 patients studied (18 with SJS or SJS-TEN overlapping and 9 with TEN), combination therapy with adalimumab significantly reduced mucocutaneous reepithelization time and healing duration compared to corticosteroid monotherapy. Patients receiving adalimumab combined with corticosteroids had lower actual mortality rates than those on corticosteroid monotherapy. The combination therapy also showed a trend towards reducing standardized mortality rates based on the Score of Toxic Epidermal Necrolysis (SCORTEN). Conclusion The findings suggest that adalimumab in combination with corticosteroids provides significant clinical benefits and is safer than corticosteroids alone for treating SJS/TEN induced by targeted anticancer therapies and immunotherapies. This study contributes valuable insights into potential treatment strategies for severe cutaneous adverse reactions to anticancer drugs, highlighting the importance of exploring alternative therapies such as TNF-α inhibitors in managing these conditions effectively.

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Immune checkpoint inhibitor associated epidermal necrosis, beyond SJS and TEN: a review of 98 cases

Bray,

Lin,

et al. 2024

Arch Dermatol Res

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Pembrolizumab associated Stevens–Johnson syndrome with porokeratosis in a patient in the setting of primary hepatocellular carcinoma

Cited by 6 publications

References 10 publications

Immune checkpoint inhibitor‐induced epidermal necrolysis: A narrative review evaluating demographics, clinical features, and culprit medications

Immune checkpoint inhibitor‐induced epidermal necrolysis: A narrative review evaluating demographics, clinical features, and culprit medications

Emerging Insights into Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Immune Checkpoint Inhibitor and Tumor-Targeted Therapy

Immune checkpoint inhibitor associated epidermal necrosis, beyond SJS and TEN: a review of 98 cases

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