Stevens–Johnson syndrome associated with radiation recall dermatitis in a patient treated with immune checkpoint inhibitor

Horii, Motoki; Kobayashi, Tadahiro; Maeda, Satoshi; Takehara, Kazuhiko; Matsushita, T.

doi:10.1111/1346-8138.15027

Cited by 9 publications

(14 citation statements)

References 4 publications

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“…SCARs encompass DRESS/ DIHS, SJS, TEN, and acute generalized exanthematous pustulosis [44]. SCARs are scarcely reported with CPIs [45][46][47][48][49][50][51]. Considering that a maculopapular or a nonspecific rash may precede life-threatening reactions, dermatologic consultation and possibly a skin biopsy is recommended.…”

Section: E Severe Cutaneous Adverse Reactions (Scars)/ Life-threatening Drug Reactionsmentioning

confidence: 99%

Cutaneous Adverse Events of Immune Checkpoint Inhibitors: A Literature Review

Apalla

Papageorgiou

Lallas

et al. 2021

Dermatol Pract Concept

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Immune checkpoint inhibitors (CPIs) are targeted molecules that modulate the immune system, assist with self-tolerance, and minimize collateral tissue damage when immune responses are activated. Although they are characterized by a favorable risk/benefit ratio, immune checkpoint blockade has been associated with a new subset of autoimmune-like toxicities, named immune-related adverse events (irAE). Dermatologic reactions are among the most prevalent irAE triggered by CPIs. In a majority of cases they are self-limiting and readily manageable. However, it is not uncommon that they result in severe skin involvement and impairment of patients’ quality of life. Awareness of the spectrum of cutaneous irAEs is mandatory for every clinician involved in the management of oncologic patients. The role of the dermatologists is essential because early recognition and appropriate management of skin toxicity may prevent dose modifications and discontinuation of CPIs. The latter is particularly relevant, considering that recent data suggest favorable oncologic response in patients developing irAEs.

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Section: E Severe Cutaneous Adverse Reactions (Scars)/ Life-threatening Drug Reactionsmentioning

confidence: 99%

Cutaneous Adverse Events of Immune Checkpoint Inhibitors: A Literature Review

Apalla

Papageorgiou

Lallas

et al. 2021

Dermatol Pract Concept

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“…Increased radiosensitization has been reported with many TT and ICI. Horii et al [ 12 ] reported pembrolizumab-associated Stevens-Johnson syndrome (SJS) as radiation recall dermatitis in a patient with malignant melanoma. In this case, pembrolizumab was initiated before RT and continued concurrently with RT.…”

Section: Discussionmentioning

confidence: 99%

Radiation Recall Dermatitis in Patients Treated With Immune Checkpoint Inhibitors: A Case Report and Literature Review

Yigit

Güven

Aksoy

et al. 2021

Cureus

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Radiation recall dermatitis (RRD) is defined as a skin reaction in the previously irradiated area triggered by a systemic agent's administration. The use of immune checkpoint inhibitors (ICI) alone and in combination with other treatments is increasing in many cancers. ICI-associated radiation recall reactions such as dermatitis, pneumonia, and myelitis have been reported so far. We report a case of nivolumab (antiprogrammed cell death protein-1 antibody) induced RRD in a patient with head and neck cancer and review the publications reporting RRD associated with other ICI in the literature. The patient was diagnosed with neck metastasis of unknown primary origin and underwent surgery followed by adjuvant chemoradiotherapy (CRT). During the follow-up, radiotherapy (RT) was performed to the left parotid region, right neck level 1b, and the left neck skin due to recurrence. After three months of the last RT session, she was started on nivolumab due to the metastatic disease. Four weeks later, she was represented with erythematous squamous plaque-like lesions starting from the left temporomandibular region and spreading to the anterior chest, which corresponded to the previously irradiated area. A biopsy was performed with the differential diagnosis of skin metastases which revealed subacute spongiotic dermatitis. The lesions completely regressed in two weeks with the use of topical steroids and antihistamine tablets. Nivolumab treatment was not interrupted, and no reaction was observed during or after the next cycle. Although RRD is rarely encountered clinically, it is a diagnosis that should be kept in mind while continuing treatment with systemic agents in patients with a history of RT. With the widespread use of ICI, RRD associated with these treatments could be better defined and appropriately managed.

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“…d 9 days -erythema and erosion of irradiated areas only; 11 days -erythema spread to non-irradiated areas. Per Horri et al 40 RRD developed into SJS (n=2), maculopapular rash with RD (n=1), and bullous pemphigoid (n=1). Of note, one patient experienced lichen planus associated with ICI plus RT on two different occasions and thus was counted as two individual cases.…”

Section: Skin Reaction Management Histologymentioning

confidence: 99%

“…23,[27][28][29][30][31][32][33][34][35] When RT was started while on ICI therapy (n=9), the cutaneous reactions occurred in a median of 73 days from the start of ICI therapy and a median of 17.5 days from the last RT. 25,26,[37][38][39][40][41][42] There was one reported case of a cutaneous reaction occurring when ICI therapy was started while patient was already on RT therapy occurring in 21 and 28 days from start of ICI and RT, respectively. 36 No case reports mentioned prior history of skin disease with the exception of Komori et al 26 in which the patient had a previous history of lichen planus secondary to combination therapy as previously reported by Komori et al 25 ICI induced RRD was the most common reported skin toxicity in our literature search (n=10).…”

Section: Skin Reaction Management Histologymentioning

confidence: 99%

Review of Immune Checkpoint Inhibitors and Radiotherapy Related Skin Toxicities

Kaszycki¹,

Leventhal²

2021

J Dermatol & Skin Sci

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Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, and their use in combination with radiation therapy (RT) has become increasingly utilized to optimize positive outcomes. The cutaneous adverse reactions from RT as well as ICIs are both well documented; however, in combination these cutaneous toxicities can be exacerbated. ICIs and RT may work synergistically to create an enhanced immune response against the tumor cells. This synergistic effect has been reported to occur both locally at the site of RT, as well as systemically via an abscopal effect. Fortunately, this combination of treatment does not increase the incidence of cutaneous reactions, although several cases have reported enhanced skin toxicity at the site of RT. RT is thought to create an ‘immunocompromised skin district’ or localized immune dysregulation in irradiated skin. This review summarizes previously published case reports and discusses the cutaneous adverse reactions from ICI and RT combination therapy. Properly identifying ICI and RT induced skin reactions depends on several factors including patient history, sequence of therapies, timing of reaction, and histological findings. Skin reactions from combination therapy can range in severity and include ICI-induced radiation recall dermatitis, as well as uncommon presentations of Stevens-Johnson syndrome, lichen planus, and bullous pemphigoid which are localized to or enhanced within areas of prior radiation exposure. It is important for oncologists and dermatologists alike to be aware of the spectrum of reactions associated with ICI and RT.

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Stevens–Johnson syndrome associated with radiation recall dermatitis in a patient treated with immune checkpoint inhibitor

Cited by 9 publications

References 4 publications

Cutaneous Adverse Events of Immune Checkpoint Inhibitors: A Literature Review

Cutaneous Adverse Events of Immune Checkpoint Inhibitors: A Literature Review

Radiation Recall Dermatitis in Patients Treated With Immune Checkpoint Inhibitors: A Case Report and Literature Review

Review of Immune Checkpoint Inhibitors and Radiotherapy Related Skin Toxicities

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