Publication date: Available online 17 July 2018
Source: Journal of the American Academy of Dermatology
Author(s): Jacob Siegel, Mariam Totonchy, William Damsky, Juliana Berk-Krauss, Frank Castiglione, Mario Sznol, Daniel P. Petrylak, Neal Fischbach, Sarah B. Goldberg, Roy H. Decker, Angeliki M. Stamatouli, Navid Hafez, Earl J. Glusac, Mary M. Tomayko, Jonathan S. Leventhal
Abstract
Background
Bullous disorders associated with anti-PD-1/PD-L1 therapy are increasingly reported and may pose distinct therapeutic challenges. Their frequency and impact on cancer therapy are not well established.
Objective
To evaluate the clinical and histopathologic findings, frequency, and impact on cancer therapy of bullous eruptions due to anti-PD-1/PD-L1 therapy.
Methods
We retrospectively reviewed the medical records of patients evaluated by the onco-dermatology clinic and consultative service of Yale New Haven Hospital from 2016 to 2018.
Results
We identified 9 patients who developed bullous eruptions of 853 patients (∼1%) treated with anti-PD-1/PD-L1 therapy at our institution during the study period: 7 presented with bullous pemphigoid, 1 presented with bullous lichenoid dermatitis, and 1 presented with linear IgA bullous dermatosis in the context of vancomycin therapy. 8 patients required systemic steroids, 5 required maintenance therapy, and 8 required interruption of immunotherapy. All 9 patients had an initial positive tumor response or stable disease, but 4 went on to develop disease progression.
Limitations
This was a retrospective study from a single tertiary care center.
Conclusion
Bullous disorders developed in approximately 1% of patients treated with anti-PD-1/PD-L1 therapy at our institution and frequently resulted in interruption of immune therapy and management with systemic corticosteroids and occasionally steroid-sparing agents.
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