Background

There is increasing recognition of distinct inflammatory eruptions associated with checkpoint inhibitors. A better understanding of their severity, therapeutic response, and impact on cancer treatment is needed.

Objective

To analyze the different rashes associated with immunotherapy referred to our institution's oncodermatology clinic and inpatient consultative service and to evaluate their therapeutic response and impact on immunotherapy.

Methods

We retrospectively reviewed the medical records of patients referred to the oncodermatology clinic or inpatient dermatology service during 2016-2018 at Yale-New Haven Hospital for eruptions that developed during immunotherapy.

Results

In total, 98 patients (51 men, 47 women) treated with checkpoint inhibitors developed 103 inflammatory eruptions, with a range of mean latency of 0.2-17.7 months. A minority of patients (25/103; 24.3%) required immunotherapy interruption; most of these cases involved immunobullous (7/8; 87.5%), lichenoid (8/26; 30.8%), maculopapular (6/18; 33.3%), and Stevens-Johnson syndrome–like (2/2, 100%) reactions. Only 3 of 16 (18.8%) patients who had their immunotherapy interrupted had a grade 2 or 3 flare on rechallenge. Most reactions (93/103; 90.3%) responded to dermatologic therapy or immunotherapy interruption.

Limitations

This was a retrospective study from a single tertiary care center.

Conclusion

A variety of inflammatory reactions might occur from immunotherapy with differing degrees of severity. While most rashes responded to topical treatment, immunobullous and exfoliative presentations frequently interrupted immunotherapy. Increased awareness and early recognition could reduce the need for unnecessary immunotherapy interruption.

中文翻译：

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与免疫检查点抑制剂疗法相关的炎性爆发：单机构回顾性分析，根据毒性对反应进行分层，对管理产生影响

背景

人们越来越多地认识到与检查点抑制剂相关的明显炎性爆发。需要对它们的严重性，治疗反应以及对癌症治疗的影响有更好的了解。

客观的

要分析与免疫疗法相关的各种皮疹，请联系我们机构的肿瘤内科诊所和住院咨询服务，并评估其治疗反应和对免疫疗法的影响。

方法

我们回顾性审查了2016-2018年期间耶鲁-纽黑文医院转诊到内科皮肤病诊所或住院皮肤科服务的患者的病历，以了解免疫治疗期间出现的皮疹。

结果

总共有98例接受检查点抑制剂治疗的患者（51例男性，47例女性）发生了103例炎症性发作，平均潜伏期为0.2-17.7个月。少数患者（25/103； 24.3％）需要中断免疫治疗；这些病例大多数涉及免疫性肿块（7/8; 87.5％），类苔藓（8/26; 30.8％），斑丘疹（6/18; 33.3％）和类史蒂文斯-约翰逊综合征（2/2，100％）反应。在接受免疫治疗中断的16名患者中，只有3名（18.8％）在再次攻击时出现2级或3级发作。大多数反应（93/103； 90.3％）对皮肤病学治疗或免疫治疗中断有反应。

局限性

这是来自单个三级护理中心的一项回顾性研究。

结论

免疫疗法可能会以不同的严重程度发生多种炎症反应。尽管大多数皮疹对局部治疗均有效，但免疫肿块和剥脱性症状经常会中断免疫治疗。意识增强和早期识别可以减少不必要的免疫治疗中断。