Psoriasis caused by pembrolizumab treatment in advanced melanoma: A positive prognostic side effect?

D’Erme, Angelo Massimiliano; Fidanzi, Cristian; Janowska, Agata; Allegrini, Giacomo; Barbara, C.; Cupini, Samanta; Viacava, Paolo; Bagnoni, Giovanni

doi:10.1111/dth.15050

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…Heterogeneous are also the neoplastic pathologies that can be associated with psoriasis induced by pembrolizumab. Indeed, there have been reported cases associated with lung [3], bladder [8], gastric [11], and cutaneous (melanoma [12,13]) cancers.…”

Section: Discussionmentioning

confidence: 99%

“…The reaction followed a reasonable temporal sequence after pembrolizumab, followed a recognized response to the suspected drug, and was confirmed by improvement on withdrawing the drug and reappeared on reexposure without apremilast. Treatments of pembrolizumab-induced psoriasis have included systemic corticosteroids, acitretin [3,12], and apremilast [7,13].…”

Section: Discussionmentioning

confidence: 99%

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Pembrolizumab-Induced Rupioid Psoriasis Treated by Apremilast Without Interrupting the Ongoing Antineoplastic Treatment

Ambrogio,

Rubino,

Laface

et al. 2024

Cureus

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We report the case of a 77-year-old man affected by a poorly differentiated metastatic pulmonary adenocarcinoma who, after the first course of therapy with cisplatin-pemetrexed-pembrolizumab treatment, developed rupioid psoriasis. We decided to discontinue pembrolizumab for four weeks until lesions improved and to start therapy with apremilast (an oral small molecule phosphodiesterase (PDE)4 inhibitor) in combination with systemic methylprednisolone 16 mg/day with consequent tapering until discontinuation in a few weeks.After accomplishing three months of treatment with apremilast, the patient gained complete remission of the rupioid lesions. Pembrolizumab therapy was reintroduced, and cycles were carried out without exacerbating the clinical picture. During the fourth month of therapy with apremilast, it was attempted to stop the treatment despite continuing the therapy with pembrolizumab. As a result, there was a relapse of the erythematous scaling plaques. After the subsequent reintroduction of apremilast, a new remission of the clinical picture occurred despite the absence of interruption of pembrolizumab. As far as we know, this is the second case of rupioid psoriasis induced by immunotherapy with pembrolizumab. Still, while the previous case was undergoing therapy with acitretin and methylprednisone, our patient is the first case treated with apremilast with excellent and rapid remission even after discontinuation and re-administration of pembrolizumab without exacerbation of dermatitis. In addition, the appearance of psoriasis during immunotherapy can be properly treated, which does not contraindicate the continuation of the antineoplastic treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pembrolizumab-Induced Rupioid Psoriasis Treated by Apremilast Without Interrupting the Ongoing Antineoplastic Treatment

Ambrogio,

Rubino,

Laface

et al. 2024

Cureus

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“…According to PRISMA guidelines, we performed a medical literature search across several databases (PubMed, Medline, Google Scholar) using the search terms “immune checkpoint inhibitor-induced psoriasis/psoriasiform dermatitis/psoriasis arthritis”. We identified and revised 80 relevant publications and included the most important data provided by these studies in Table S1 [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ,…”

Section: Review Of the Literaturementioning

confidence: 99%

Perspectives on Psoriasiform Adverse Events from Immune Checkpoint Inhibitors: Lessons Learned from Our Practice

Popa,

Giurcaneanu,

Portelli

et al. 2024

Medicina

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Background: New oncologic therapies, including immune checkpoint inhibitors (ICIs), have revolutionized the survival and prognosis of cancer patients. However, these therapies are often complicated by immune-related adverse effects (irAEs) that may impact quality of life and potentially limit their use. Among these adverse events are psoriasis and psoriatic arthritis that may develop de novo or flare under treatment with ICIs. Given the exceptional immune status of patients receiving ICIs, managing these conditions without interfering with the effect of the oncologic treatment may prove very challenging. Aim: To review the literature data on ICI-induced psoriasis exacerbation or development, to present our own experience, and to discuss the pathogenic mechanisms underlying this association and the optimal therapeutic approach for these patients. Case Reports: We report three cases of ICI-induced de novo psoriasis and two cases of ICI-induced psoriasis exacerbation that required systemic treatment. Oral acitretin treatment successfully controlled psoriasis lesions in three cases and allowed for the continuation of immunotherapy. Literature Review: We performed a medical literature search across several databases (PubMed, Medline, Google Scholar) using the search terms “immune checkpoint inhibitor-induced psoriasis/psoriasiform dermatitis/psoriasis arthritis”. We identified and revised 80 relevant publications that reported 1102 patients with psoriasis and/or psoriasis arthritis induced or exacerbated by ICIs. We assessed the type of cancer, the therapeutic agent involved, the clinical form of psoriasis, the presence or absence of psoriatic arthritis, the personal and family history of psoriasis, the age, the gender, the time until onset or exacerbation of skin lesions, the specific treatment recommended, the need for ICI discontinuation, and the patient’s outcome. Conclusions: As ICIs represent a fairly novel therapy, the association with several adverse effects is only now unraveling. Psoriasis exacerbation or onset following the initiation of immunotherapy is one such example, as more and more reports and case series are being published. Awareness of the relationship between psoriasis and treatment with ICIs, prompt recognition, and initiation of adequate skin-directed therapies are essential for the avoidance of skin lesions worsening, the need for systemic treatments that may interfere with ICIs’ effects, or the discontinuation of the latter. In the absence of generally accepted guidelines, it is advisable to treat patients with severe, widespread psoriasis with drugs that do not impair the effects of immunotherapy and thus do not alter the patient’s prognosis.

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“…1 However, the development of cutaneous immune-related adverse events (cirAE) can severely impact the quality of life and result in discontinuation of ICI therapy. 2 They occur in 70%-90% of patients undergoing this kind of treatment. 3 Recently, we found psoriasiform, morbilliform and lichenoid dermatoses associated with ICI, bullous disorders (like bullous pemphigoid) and severe cutaneous adverse events.…”

Section: Immunotherapy-induced Eczema Treated With Dupilumabmentioning

confidence: 99%

“…3 Recently, we found psoriasiform, morbilliform and lichenoid dermatoses associated with ICI, bullous disorders (like bullous pemphigoid) and severe cutaneous adverse events. 1,2,4 We report two cases of histology-confirmed eczema developed under the treatment with ICI, successfully managed with dupilumab.…”

Section: Immunotherapy-induced Eczema Treated With Dupilumabmentioning

confidence: 99%

Immunotherapy‐induced eczema treated with dupilumab

D'Erme,

Fidanzi,

Mori

et al. 2023

Acad Dermatol Venereol

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Psoriasis caused by pembrolizumab treatment in advanced melanoma: A positive prognostic side effect?

Cited by 3 publications

References 10 publications

Pembrolizumab-Induced Rupioid Psoriasis Treated by Apremilast Without Interrupting the Ongoing Antineoplastic Treatment

Pembrolizumab-Induced Rupioid Psoriasis Treated by Apremilast Without Interrupting the Ongoing Antineoplastic Treatment

Perspectives on Psoriasiform Adverse Events from Immune Checkpoint Inhibitors: Lessons Learned from Our Practice

Immunotherapy‐induced eczema treated with dupilumab

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