Pembrolizumab-induced toxic epidermal necrolysis: case report

Chow, Kar Ven Cavan; O’Leary, Connor; Paxton-Hall, Fiona; Lambie, Duncan; O’Byrne, Kenneth J.

doi:10.1093/omcr/omac025

Cited by 9 publications

(5 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%

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%

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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“…Similar to our case, they reported resolution of the rash after initiation of prednisone, and the patient did not develop any further rash at the one-month follow-up [ 7 ]. In another case report by Chow et al [ 8 ], a 63-year-old male with metastatic lung adenocarcinoma presented with TEN approximately 10 weeks after the first cycle of pembrolizumab, carboplatin, and pemetrexed. Due to the significant skin involvement, the patient was treated with high-dose methylprednisolone, cyclosporine, intravenous immunoglobulin, antibiotics, and skin care [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In another case report by Chow et al [ 8 ], a 63-year-old male with metastatic lung adenocarcinoma presented with TEN approximately 10 weeks after the first cycle of pembrolizumab, carboplatin, and pemetrexed. Due to the significant skin involvement, the patient was treated with high-dose methylprednisolone, cyclosporine, intravenous immunoglobulin, antibiotics, and skin care [ 8 ]. They reported excellent recovery of skin lesions with minimal sequelae [ 8 ], further supporting the role of immunosuppressive therapy in the treatment of SJS/TEN.…”

Section: Discussionmentioning

confidence: 99%

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Pembrolizumab-Associated Stevens-Johnson Syndrome in a Patient With Metastatic Non-small Cell Lung Cancer: A Case Report

Sandhu¹,

Kc²,

Bhandari³

et al. 2023

Cureus

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Pembrolizumab is a monoclonal antibody that binds to the programmed cell death-1 (PD-1) receptor and is approved for the treatment of several malignancies. We present a rare case of Stevens-Johnson syndrome (SJS) occurring in a 75-year-old female 14 days after receiving the first dose of pembrolizumab therapy to treat stage IV non-small cell carcinoma of the lungs with metastasis to the brain. Although pruritus and papular, erythematous rashes are documented after its use, severe reactions such as SJS and toxic epidermal necrolysis (TEN) are rarely seen in clinical practice. In addition to supportive care, the patient also received intravenous immunoglobulin (IVIG) and corticosteroid therapy and responded well to the therapy. Nearly complete re-epithelialization was achieved four weeks after the start of skin lesions. This case highlights a rare phenomenon of SJS- and TEN-associated adverse reactions following treatment with pembrolizumab.

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“…Cyclosporine is a calcineurin inhibitor that is FDA-approved for the prevention of solid organ transplant rejection and certain autoimmune diseases, including psoriasis and rheumatoid arthritis. This medication has also been used for the treatment of various irAEs, including lichenoid eruptions and toxic epidermal necrolysis [18][19][20]. While this use is off-label, the American Society of Clinical Oncology (ASCO) and NCCN recommend the use of cyclosporine for grade 4 Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and drug-induced hypersensitivity syndrome (DIHS) that failed to respond to corticosteroids [3,21].…”

Section: Cyclosporinementioning

confidence: 99%

Safety of Immunomodulatory Systemic Therapies Used in the Management of Immune-Related Cutaneous Adverse Events

Gu,

Nath,

Markova

2023

Pharmaceuticals

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Immune-related cutaneous adverse events (ircAEs) commonly occur in patients on treatment with immune checkpoint inhibitors and can significantly reduce patient quality of life. These are often treated with immunomodulatory agents, including glucocorticoids, immunosuppressants, and biologics. While often effective at managing symptoms, these therapies can cause several adverse events which may limit their use. In addition, immunomodulatory agents should be used with particular caution in patients receiving immunotherapy, as the efficacy of the oncologic regimen may potentially be undermined. In this review, we summarize the safety of systemic therapies that are used in the management of ircAEs, with a particular focus on the resultant risk of secondary tumor progression in patients with active cancer.

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Pembrolizumab-induced toxic epidermal necrolysis: case report

Cited by 9 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

Pembrolizumab-Associated Stevens-Johnson Syndrome in a Patient With Metastatic Non-small Cell Lung Cancer: A Case Report

Safety of Immunomodulatory Systemic Therapies Used in the Management of Immune-Related Cutaneous Adverse Events

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