Pembrolizumab-induced autoimmune Stevens-Johnson syndrome/toxic epidermal necrolysis with myositis and myocarditis in a patient with esophagogastric junction carcinoma: a case report

Cao, Jianzhu; Qiu, Li; Zhi, Xiao; Yang, Fan; Zhu, Weipeng; Zhou, Ting; Hou, Xianming; Chen, Donghong

doi:10.21037/tcr-21-470

Cited by 14 publications

(9 citation statements)

References 15 publications

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“…After a review of 1,258 citations in PubMed and the Cochrane Library, 14 case reports, including 14 patients, met the selection criteria of our systematic review ( Saibil et al, 2019 ; Salem et al, 2019 ; Shirai et al, 2019 ; Giancaterino et al, 2020 ; Lie et al, 2020 ; Matsui et al, 2020 ; Todo et al, 2020 ; Xing et al, 2020 ; Cao et al, 2021 ; Deng et al, 2021 ; Hu et al, 2021 ; Jespersen et al, 2021 ; Yang et al, 2021 ; Shindo et al, 2022 ) ( Figure 5 ). The clinical characteristics and prognosis of the 14 patients are summarized in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Related Myositis Overlapping With Myocarditis: An Institutional Case Series and a Systematic Review of Literature

et al. 2022

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Background: Immune checkpoint inhibitor (ICI)-related myositis with myocarditis is a rare but potentially fatal immune-related adverse event. However, its clinical features, response to immunosuppressive treatment, and prognosis remain poorly understood. Here, we describe the clinical course of patients with ICI-related myositis overlapping with myocarditis treated at our institution and a systematic review focusing on the response to immunosuppressive therapy.Methods: We identified patients who developed ICI-induced myositis with myocarditis and were treated at our hospital using a retrospective chart review of electronic medical records. For the systematic review, studies reporting ICI-induced myositis with myocarditis were identified using the Cochrane Library and PubMed databases.Results: Of the 625 patients treated with ICIs, four developed myositis with concurrent myocarditis. All the patients received immunosuppressive therapy. We assessed the activity of myocarditis and myositis based on temporal changes in troponin and creatine kinase (CK) levels. In all patients, peak troponin values appeared later than the peak CK values (median, 17 days). The median time from the start of ICI therapy to the peak of troponin and CK levels was 42.5 and 28 days, respectively. In all patients, CK levels decreased rapidly and steadily after the initiation of immunosuppressants. However, troponin levels were unstable and increased. In all patients, CK levels normalized within one month (range, 12–27 days), but troponin levels took several months to normalize (range, 84–161 days). Fourteen cases of ICI-related myositis with myocarditis were included in the systematic review. Of the 14 cases, 12 (86%) had their CK level decreased after the initial steroid treatment, but the troponin level increased and was higher than that before the start of treatment. In addition, the peak troponin values appeared later than the peak CK values (a median of 6.5 days). Eight (89%) of 9 long-term follow-up patients had troponin levels above the normal range even after CK normalization.Conclusion: In most cases of ICI-related myositis with myocarditis, troponin levels increased after the initial steroid treatment despite decreased CK levels, and exceeded pre-steroid levels. In addition, troponin remained elevated for several months after CK normalized.

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Section: Resultsmentioning

confidence: 99%

Immune Checkpoint Inhibitor-Related Myositis Overlapping With Myocarditis: An Institutional Case Series and a Systematic Review of Literature

et al. 2022

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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%

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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“…The median onset time is about 25.5 days [ 166 ], ranging from 15 to 90 days of treatment initiation [ 145 , 146 , 167 ]. Initially, patients present with fever, headache, cough, and/or sore throat.…”

Section: Methodsmentioning

confidence: 99%

Immune-Related Uncommon Adverse Events in Patients with Cancer Treated with Immunotherapy

et al. 2022

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Immunotherapy has dramatically changed the therapeutic landscape of oncology, and has become standard of care in multiple cancer types in front or late lines of therapy, with some longstanding responses and outstanding results. Notwithstanding, its use has brought a totally unique spectrum of adverse events, characterized by a myriad of diverse manifestations affecting nearly every organ and system of the body, including the endocrine, nervous, cardiac, respiratory and gastrointestinal systems. Uncommon adverse events, defined as those occurring in less than 1% of patients, comprise an even more heterogeneous group of diseases that are being seen more recurrently as the use of immune check-point inhibitors increases and indications spread in different tumor types and stages. Here, we comprehensively review some uncommon, but exceedingly important, immune-related adverse events, with special emphasis in the clinical approach and diagnostic workup, aiming to reunite the evidence published previously, allowing an increase in awareness and knowledge from all specialists implicated in the diagnosis, treatment, and care of cancer patients treated with immunotherapy.

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Pembrolizumab-induced autoimmune Stevens-Johnson syndrome/toxic epidermal necrolysis with myositis and myocarditis in a patient with esophagogastric junction carcinoma: a case report

Cited by 14 publications

References 15 publications

Immune Checkpoint Inhibitor-Related Myositis Overlapping With Myocarditis: An Institutional Case Series and a Systematic Review of Literature

Immune Checkpoint Inhibitor-Related Myositis Overlapping With Myocarditis: An Institutional Case Series and a Systematic Review of Literature

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

Immune-Related Uncommon Adverse Events in Patients with Cancer Treated with Immunotherapy

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